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Tips For Traveling With Panic Disorder and Anxiety

Travel can trigger panic and anxiety symptoms

If you have panic disorder , panic attacks and anxiety-related symptoms might keep you from traveling. Being in new and strange places, away from the safety of your home, can make you feel insecure. You may also be afraid of others witnessing your fear and nervousness. Fortunately, there are a number of steps you can take to manage your symptoms while traveling so you can enjoy your trip.

Tips for Managing Travel Anxiety

Try any of these tips or combine several of them to make your next trip more manageable.

Be Prepared

When making your travel plans, also put some effort into planning and preparing how you're going to deal with your symptoms. The anticipation of uneasy travel will often bring on more stress and anxiety about your upcoming trip. Be ready to face your panic attacks by having a plan of coping skills ready beforehand.

For example, deep breathing techniques , visualization , or meditation may be all you need to counter your fears. There is even some research that suggests playing a difficult game of chess on your cell phone may be an effective way to successfully treat panic attacks.  

Practice these relaxation techniques and self-help strategies in the weeks before you travel. Regular practice is key to learning to sit with uncomfortable thoughts. As a result, you may find your symptoms stay under control on your next trip.

Use Distractions

When traveling, it's not uncommon to focus more on your symptoms. One way to manage them is to put your focus elsewhere. Instead of concentrating on the sensations in your body, try to bring your attention to other activities. For example, you can bring along a good book, favorite magazines, or enjoyable games.

Turn your negative thoughts around by diverting your attention to happier thoughts or visualize yourself in a serene scene. Use affirmations to center on more calming thoughts, such as repeating to yourself “I am safe” or “These feelings will pass.” You can also bring awareness to your breath. Focusing on your breath can have a calming effect.

Calming Breath Exercise

Start by breathing slowly and purposefully. You can become even more focused by counting each of your breaths, counting on each refreshing inhalation and again on each deep exhalation. Once your breath has steadied, you can also relax your body.

Intense feelings of panic and anxiety can bring tension and tightness throughout your body. To relieve these sensations, try doing some stretches, moving through a few yoga postures, or practicing progressive muscle relaxation (PMR) .

It can also be beneficial to focus on what you're looking forward to on your trip. Have an itinerary that will include activities you enjoy. If you’re traveling for business, see if you can schedule some time to check out a new restaurant, get a massage , or fit some exercise in at the hotel or outdoors. By concentrating on fun activities, your excitement for your trip may take over your worry.

Accept Your Symptoms

If your symptoms become too overwhelming to distract yourself from, try to simply allow them to run their course. Panic attacks often heighten within a few minutes and then gradually taper off.

If you resist your panic attacks, you may actually experience increased anxiety and panic-related fears, such as feeling that you're having a medical emergency, losing control of yourself, or going insane.

If you have panic and anxiety while traveling, try to surrender to your symptoms, reminding yourself that they will soon pass. Consistently conceding to your symptoms may reduce your fears around them and strengthen your sense of control.

Go With a Buddy

Many people with panic disorder have one or more loved ones with whom they feel comfortable and safe. If possible, try to enlist a trusted friend or family member to travel with you.

Make sure that your companion is aware of your fears and anxiety. Your loved one may be able to assist you in coping with your symptoms and boost your sense of security while traveling. For some, just having that person there is all that is needed to have a much more relaxing trip.

Consult Your Doctor

Discuss your travel concerns with your doctor or healthcare provider. It's possible you're experiencing other underlying issues or conditions, such as agoraphobia or a fear of flying ( aerophobia ). Your doctor will be able to determine if a co-occurring condition is contributing to your travel anxiety.

Your health provider may also recommend medication to treat your symptoms. Benzodiazepines are a type of anti-anxiety medication that can quickly reduce panic symptoms. Your doctor may prescribe a benzodiazepine, such as Xanax (alprazolam), Ativan (lorazepam), or Klonopin (clonazepam), to ease the intensity of your panic attacks.

A Word From Verywell

Living with panic disorder can be challenging, but your diagnosis shouldn't hold you back from having a fulfilling life. Follow these easy tips to help you manage your symptoms on your next trip. With practice and preparation, you may be able to travel without taking your panic and anxiety with you.

If you or a loved one are struggling with panic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database .

Barzegar K, Barzegar S. Chess therapy: A new approach to curing panic attack. Asian J Psychiatr. 2017;30:118-119. doi:10.1016/j.ajp.2017.08.019

National Institute of Mental Health. When Fear Overwhelms .

National Institute of Mental Health. Mental Health Medications .

By Katharina Star, PhD Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. 

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10 tips for managing travel anxiety

Reviewed by Stephanie Steinman, PhD, CSAC

Last updated: 05/04/2024

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What causes travel anxiety?

• Being away from home and loved ones
• Dealing with transportation
• Managing stress for kids or pets
• Facing language barriers
• Creating itineraries and following schedules
• Negotiating large crowds, long lines, and unexpected delays
• Absorbing high costs
• Getting around in bad weather
• Coping with exhaustion
• Having had negative travel experiences in the past

Signs to watch for

• Excessive worry or fear
• Difficulty concentrating
• Procrastination
• Irritability or frustration
• Negative thoughts
• Palpitations or a racing heart
• Shallow or rapid breathing
• Muscle tension
• Digestive issues

How to deal with travel anxiety

1. check in with yourself regularly, 2. work on changing how you think about travel, 3. identify your triggers and plan ahead for them.

• Make a list of the challenging experiences you’re worried about having.
• For each item, brainstorm ways to handle the situation in a calm way. For example, if you’re anxious about interacting in a new language, consider practicing some simple phrases at least a week before you arrive (“please,” “thank you,” “excuse me,” and “where is the restroom?” always come in handy).
• Prepare for uncertainty by picking up a phrasebook or downloading a translation app, having maps and routes ready, and looking up places whose staff may speak your language.

4. Get organized

• Make a packing list to ensure you bring what you need.
• Book accommodations and transportation ahead of time.
• Research costs for activities, restaurants, and attractions to help you plan a budget and reduce financial anxiety .
• Take care of important tasks before your trip, such as paying bills and notifying banks of your travel plans.
• Keep important documents , like passports and travel insurance information, in a safe place that’s easily accessible.
• Allow yourself advance time to prepare so you don’t feel rushed.

5. Create a realistic schedule

6. choose your travel mode thoughtfully, 7. pack comforting items, 8. spend some time in nature, 9. make mindfulness a habit, 10. ask for help as needed.

• Hodophobia , a heightened and persistent fear or anxiety about traveling
• Aerophobia , extreme fear of flying
• Thalassophobia , a fear of deep water
• Agoraphobia , a fear of leaving safe places, especially home

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542819/ 2 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00052-X/fulltext 3 https://www.sciencedirect.com/science/article/abs/pii/S2214140521001730/ 4 https://pubmed.ncbi.nlm.nih.gov/30922426/ 5 https://pubmed.ncbi.nlm.nih.gov/36749782/ 6 https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.149.7.936/ 7 https://onlinelibrary.wiley.com/doi/10.1002/cpp.680

About the author

Elise Burley is a member of the therapist.com editorial team. She has more than a decade of professional experience writing and editing on a variety of health topics, including for several health-related e-commerce businesses, media publications, and licensed professionals. When she’s not working, she’s usually practicing yoga or off the grid somewhere on her latest canoe camping adventure.

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7 Travel Anxiety Tips to Ease Stress, According to a Psychiatrist

These seven tips can help calm travel anxiety.

Travel is a gift. It makes us more connected to the world, can inspire us in ways we never imagined, and helps us bond with loved ones along the way. It can also leave us rather frazzled with anxiety.

Travel anxiety is nothing to be ashamed of, and if you have it, you’re far from alone.  According to WebMD , some 18% of the U.S. population has an anxiety disorder. 

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“Travel can be really stress-inducing because so many things are outside of your control,” Dr. Nina Vasan, chief medical advisor at Zeera (formerly known as Real) and professor at Stanford, shared with Travel + Leisure . “From weather and mechanical delays to traffic and lost bags, there are a lot of stressors that you can’t necessarily plan for or solve. Things that happen while you’re traveling can also have huge impacts on your day or life.” 

There are, however, a few tools you can add to your mental health arsenal to help. Here are seven travel anxiety tips to help ease stress on your next trip.

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Pack an item that brings you joy.

If you’re prone to travel anxiety, Vasan suggests packing one item that makes you feel happier, no matter what that is. 

“Think of a few things to bring with you to make it a joyful or calming experience. This is different for everyone,” Vasan shared. “For example, think of things you enjoy: a new book, a new TV show you’ve wanted to watch, a podcast, or something to entertain you that will make travel more fun.” For a dedicated yogi, it might be a travel yoga mat that allows them to practice wherever they want.

Channel nervous energy. 

Feeling out of control? Find something to distract you — specifically, something to distract your hands. 

“Find something you can do with your hands to channel nervous energy, like knitting, coloring, needlepoint, writing letters or postcards, and journaling. This allows you to be creative and use the time you’re spending in transit in a way that is fulfilling and can make it feel less stressful,” Vasan said. 

Plan your meals.

Vasan said you shouldn’t leave anything up to chance, including your meals. 

“Food can be a stressor for a variety of reasons. Maybe you’re hungry in transit. Or maybe you don’t see any food options you like,” Vasan said. “Think ahead about what you want to be eating and plan accordingly. Maybe that means packing food for the trip. Or if you’re planning to eat out, think ahead to what you might find satisfying.” 

Westend61/Getty Images

Give yourself extra time.

The last thing you want to do is pile on more stress by being late. So, Vasan said, it’s good to pad in extra time while in transit. 

“The travel experience has become much more stressful lately, especially airline travel. Give yourself extra time to plan ahead for any delays or things that might unexpectedly happen. Having the extra buffer time will make your travel feel much less stressful,” Vasan said. If you end up with too much extra time, find something to do – like catching up with a friend or loved one or walking around the train terminal or airport.

Try calming breathing techniques.

What is one thing you can do anywhere, at any time? Take a deep breath.

“Deep breathing, mindfulness, and meditation are absolutely fantastic,” Vasan said. “I like diaphragmatic breathing to ease anxiety and stress. It is a deeper style of breathing, and I think that physical component can be really useful in releasing stress.” 

Move your body.

Another way to get your body prepared for stress-free travel is to move a little.

“Physical movement is incredibly helpful in reducing stress. Adding just five minutes here and there can be really helpful,” Vasan shared. “Maybe it is taking the stairs instead of the elevator or power walking around the airport terminal during your layover. Movements can be a game-changer.” 

Andrew Holt/Getty Images

Have a backup plan. 

One more way to reduce your chances of running into any travel stress is to always have a backup plan so you’re never left out in the cold. 

“Contingency planning ahead of time can be helpful when it comes to work and family responsibilities,” Vasan added. “Before you start traveling, think ahead – if your return flight home gets canceled, what are you going to do? Having a ‘crisis plan’ in place can decrease anxiety because you already know what you’re going to do.” 

And don’t be afraid to ask for professional help.

Still feeling overwhelmed? Ask for help.

“If it is at the level where your stress is prohibiting you from traveling, or you notice the stress so much that it is getting in the way of you having a good experience while traveling, I think that means it is hitting the level where a professional can help.” So go ahead and make an appointment with your therapist (or check out the online services at Zeera) to get over any hurdles so you can focus on having the best travel experience of your life instead. 

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How To Manage Travel Anxiety

What is travel anxiety.

Traveling can be a rewarding and enriching experience, but it can also seem intimidating if you live with anxiety. The prospect of navigating unfamiliar situations and managing logistics can be stressful, and you might worry that you won’t be able to fully enjoy your trip as a result of your symptoms. How can you manage travel anxiety so that your journey is a success? While each person and travel scenario is different, there are a variety of techniques you can try that may help keep your travel-related anxieties in check so that they don’t hold you back from exploring new places.

Defining travel anxiety vs. an anxiety disorder

Generalized anxiety disorder (gad), panic disorder .

People with this disorder  experience panic attacks  along with potentially disruptive fears about how or where these attacks may manifest in the future. They might find it hard to stop worrying about what would happen if they had a panic attack while in an airport or in a place where they don’t speak the language.

Social anxiety disorder

Also known as social phobia, this involves an intense fear  of being watched, judged, humiliated, or rejected by other people. Since traveling virtually always means interacting with strangers and being around large groups, it can be a trigger for those with this disorder.

Agoraphobia

Techniques for managing fear of flying or traveling.

So, how can you avoid letting nerves ruin your travel experience? The following strategies could help you manage your symptoms so you can enjoy your time away.

Identify your triggers for travel anxiety

Even if you feel anxious about the entire idea of the trip you’re planning, there are likely certain aspects of travel that are particularly stressful for you. Many people with anxiety disorders have specific triggers that tend to provoke their most severe travel anxiety symptoms. Recognizing these triggers and thinking ahead about how to cope with them can be helpful in managing your travel anxiety.

What parts of the journey are you most anxious about? Is it the thought of looking foolish because of cultural norms you don’t know? Do you worry a lot about something going wrong with your flight? Are you concerned you might have a panic attack and be unable to get help?

Journaling or otherwise writing down your thoughts and feelings about traveling could be an effective way to identify travel anxiety-related triggers. In addition to helping you figure out which elements of the journey are causing you the most stress, studies suggest that this process  could help reduce symptoms  of anxiety and depression in and of itself.

Create a detailed plan for your fear of flying

You might be tempted to avoid thinking about what could go wrong during your travels, but this approach may only increase your fear related to travel anxiety. Instead, it could be best to confront the possible negative scenarios a week before your travel date and create a plan for how to cope with them. For instance, if you’re worried about missing your connecting flight, you could research alternative travel arrangements and deliberately leave some wiggle room in your planned arrival time. This type of planning can help make the sources of your travel anxiety seem more manageable and avoid negative psychiatric consequences.

In addition to planning for mishaps, you may also want to create a detailed itinerary to help you organize your travels. Research indicates that proactive planning  may help lower stress  by reducing uncertainty. However, you may also want to remind yourself that it’s okay if some things don’t go according to plan and that you’ll be able to adapt if things change.

Pack for self-care and prioritize your mental health

It can be easier to manage and overcome travel anxiety if you have some small sources of comfort to help bring you calm while you’re away. You may want to pack things that you can use to create little rituals of relaxation and a comfort zone no matter where you are. Possible examples include:

• Scented sachets or sprays, since research suggests that  some types of aromatherapy  could help you feel calmer in the face of travel anxiety
• An eye mask to help you get quality sleep while you’re away, which  can help keep anxiety under control
• Noise-canceling headphones to help you avoid overstimulation and find calm
• Books, crossword puzzles, handheld games, or other forms of distraction
• Workout clothes, since a short workout or even a brisk walk  may help decrease symptoms of anxiety
• A scalp massager to help ease anxiety by releasing some physical tension

Plan and budget for relaxation

Learn some anxiety reduction techniques for trip anxiety.

Exercises for mental and physical relaxation may help you reduce your symptoms of travel anxiety in the moment. Learning and practicing methods like these before your trip may help prepare you to better cope with any difficulties that could arise.

• Sensory grounding.  Grounding techniques  can redirect your attention to the world around you instead of your own anxiety, potentially preventing a panic attack. A common method is to take notice of concrete things you can perceive with each of your five senses. As a bonus, this can also help you take note of the novel sights and sounds of your travel destination.
• Meditation.  Mindfulness meditation  has shown considerable effectiveness in reducing anxiety symptoms in many people, as evidenced by research on the neural correlates of mindfulness meditation anxiety relief .  You can practice it for 10–20 minutes per day from anywhere by sitting still, breathing deeply, and noticing the thoughts and feelings that arise without judging them or trying to control them. 
• Earthing. Some studies suggest that being in contact with the ground may help lessen symptoms of anxiety, perhaps by conveying a sense of stability and comfort. This is known as “earthing”. You can try it for yourself by sitting, lying down, or planting your feet firmly and paying attention to the sensation of touching the ground.
• Expressive journaling. As we noted above,  journaling may help with worry and anxiety. Writing about what’s making you anxious instead of bottling it up could provide a constructive outlet for your emotions to lessen their intensity. Plus, taking time to also record the positive and interesting things about your travels could help cement happy memories for you to look back on later.

Connect with a loved one about your mental health

In the internet age, going to a new place doesn’t mean you can’t still lean on your support network. When your travel anxiety gets particularly strong, you may want to reach out to an understanding friend, partner, or family member to let them know what you’re feeling. You may not be able to talk with them over the phone right at that moment, but even writing out a text message or email may be comforting on its own, and you could check in via phone or video chat then or later if possible. A simple conversation with someone you trust could go a long way toward helping you feel less alone or worried in the face of travel anxiety.

Talk to a therapist about your trip anxiety

Talk therapy can be an effective way to manage and treat anxiety, including travel anxiety. If you’re getting ready for a trip and are feeling anxious about it, reaching out to a therapist beforehand to discuss your worries could be a good way to mentally prepare for travel. If you connect with a therapist online, you may be able to continue your sessions during travel as well. The ability to talk with a mental health professional from anywhere you have an internet connection is one significant benefit of online therapy platforms.

The stress that can be associated with travel may exacerbate the mental and physical symptoms of an anxiety disorder. Reducing uncertainty by planning ahead for potentially triggering situations may help you feel less anxious. You can also incorporate techniques for relaxation and mental grounding into your journey. Staying in contact with supportive friends and/or a mental health professional  may provide additional relief when your travel anxiety feels most severe. Also, therapy may serve as an effective long-term anxiety treatment even when you’re not traveling. Take the first step toward relief from anxiety and contact BetterHelp today.

Frequently asked questions

Read more below for answers to questions commonly asked about travel and anxiety disorder..

There are many reasons why you might feel anxious before traveling, also known as "travel anxiety". Your previous negative experiences, such as a major car accident during young adulthood, could create feelings of anxiety. It could be related to a fear of flying, being in crowds, or being in an unfamiliar place. Also, you might worry about your safety or feel concerned about family or obligations back at home. If you experience health conditions, you might also be nervous about finding health services while traveling.

Making a conscious effort to relax while traveling can help you avoid or decrease feelings of travel anxiety. You can focus on maintaining healthy routines as best you can, such as sleeping enough, eating well, and exercising. If you’re traveling with others in an unfamiliar place, taking time to yourself away from them may also help you recharge and relax. You can also practice meditation, breathing exercises, or similar techniques to help yourself relax no matter where you are. You might also feel more at ease if you ensure that your travel or health insurance will cover any incidents that might occur during your trip. 

What is the best sedative for flying?

If you experience high anxiety or panic attacks during air travel, it’s usually recommended that you seek the advice of a qualified healthcare professional for help coping with symptoms. A healthcare professional may ask about your physical health and any medications you’re taking and then prescribe medications for anxiety and fear of flying.

Is fear of flying a mental illness?

How can i relax when flying.

If you experience flight or travel anxiety, it may help to meet with a mental health professional to address your symptoms. You can also try to engage in various coping mechanisms to keep yourself calm, such as trying breathing techniques and grounding exercises, challenging distorted thoughts, and avoiding substances like caffeine that can intensify feelings of anxiety.

There are various relaxation techniques you can try to manage anxiety, even if it's not related to travel. Some of these include practicing breathing or grounding exercises, journaling, making healthy lifestyle changes, and speaking with a therapist.

What is the best medication for traveling anxiety?

There’s no one medication that’s right for everyone who experiences symptoms of travel anxiety, and medication in general might not be the answer for each individual who is living with an anxiety disorder. To find out what type of long term anxiety treatment might be right for you, it’s typically recommended that you consult with a mental health professional for advice and guidance that pertains to your specific situation.

Can traveling relieve stress? 

Traveling can relieve stress in some people and increase it in others. It depends on the individual, the type of trip, and other circumstances. 

Can you be a pilot if you have anxiety?

Since anxiety disorders are generally considered to be treatable, it is generally possible to pursue the career path of your choice even if you’re experiencing symptoms and/or have been diagnosed with one.

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Travel Anxiety

What is it?

Travel anxiety is when a person feels anxious when they travel or may avoid travelling due to fear surrounding this. Those with already present anxiety disorders may find that travelling exacerbates or triggers the anxiety symptoms. The main causes of travel anxiety include interacting with other people, lack of support, wayfinding and buying tickets.

With 25% of adults in England diagnosed with at least one mental illness according to the Health Survey of England, Prof Roger Mackett from UCL’s Centre for Transport Studies has carried out a survey of people with mental health conditions, in order to establish the difficulties that people with such conditions have when travelling, and to identify ways in which these can be overcome. The following articles look at some of the findings from his report:

Mental health and travel behaviour: read here

Mental health and wayfinding: read here

Policy interventions to facilitate travel by people with mental health conditions: read here

DIY self diagnosis

If you can answer YES to most of the questions it is likely that you are affected by travel anxiety. During the last 6 months:

Have you avoided travelling due to anxiety?

Have you experienced a marked, persistent and excessive fear of travelling?

Do you worry excessively about travelling?

Has traveling made current anxiety symptoms worse?

Anxiety UK strongly advises that people seek further information and guidance from their GP who will be able to make a formal diagnosis.

How we can help

By becoming a member of Anxiety UK – for just £40 per year (see all our membership) you enjoy a range of support services and resources, including:

• Access to reduced cost therapies
• One year’s free subscription to  Headspace , more details here
• Subscription to Anxious Times magazine (worth £12 annually)
• Access to our Member’s area and other free online resources
• Access to our exclusive member’s only online message boards
• Free copy of Understanding Anxiety booklet (worth £3.99)
• 25% discount on purchases of Kalms Lavender One-A-Day Capsules made via www.kalmsrange.com. This discount is exclusively for Anxiety UK members.
• 10% off a Listening Books membership (normally between £20 and £45 per year).
• Total value of more than £90 annually!
• 25% discount on Remy Sleep weighted blankets

Become a member

Recommended resources

This fact sheet gives a detailed overview, as well as a look at some of the evidence based approaches to treating driving phobia. See the resource .

It’s not unusual to feel anxious or worried before any test; none more so than a driving test, where your ability to control the car and avoid any unsafe behaviour can be challenged by a wealth of external factors. Read the whole story →

The thought of travelling to unfamiliar places and the complex rules surrounding overseas travel may be deterring you from planning a holiday and also causing additional stress and anxiety. Read the travel tips →

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7 Tips for Managing Your Anxiety About Traveling

Travel anxiety can strike even the most unflappably chill among us. Sure, it can be incredibly rewarding and rejuvenating to break out of the day-to-day and explore new places—or, you know, park horizontally on the beach for five days. But there’s no getting around the inevitable hassles that come with those perks: nightmare security lines, massive flight delays, FOMO-fueled itineraries, chaotic train stations, frustrating language barriers, worries about the work/kids/ pets /obligations you’re leaving at home. The list is endless.

When you think about it, the travel experience is practically designed to boost stress. Broadly speaking, there are two types of situations that are most likely to cause anxiety, Martin Antony , Ph.D., a psychology professor at Ryerson University in Toronto and author of The Anti-Anxiety Workbook , tells SELF. “One is when we don’t know what’s going to happen. The other is situations where we’re not in control.” What is traveling if not a series of largely unpredictable, often uncontrollable circumstances and events—some of which may be delightful, others decidedly less so?

There are also, in a sense, two major kinds of travel anxiety. One takes place when you’re actually traveling and some part of the process is going belly up. The other is the more ever-present anxiety you might feel about safety while traveling, or about how the trip is going overall.

Whether you experience one, the other, or both, there are ways to become a less anxious traveler. There’s also help out there if you don’t think you can manage on your own. Here are seven tips to get you started.

Having a 100 percent stress-free trip is simply not feasible, says Antony, who travels a few times a month for work. “There’s a lot that can go wrong when you travel, and some of these things do happen,” he says. Getting hopelessly turned around, dealing with flight delays, losing your luggage, and similar stress-inducing scenarios aren’t exactly rare events.

The simple thought of some inconvenient, unexpected circumstance crashing your travel party might ramp up your anxiety. Instead of just steeping in that stress, use it to fuel action in the areas where you do have control. This can help you avoid feeling like you’re woefully unprepared for anything that might not go according to plan. It can also offload some of the stress when something does go wrong, since you’ll at least have braced yourself for various possibilities.

That’s why Antony describes this as “normal, useful anxiety.” Someone going on a trip with no knowledge of or concern about the possible issues they could face is much more likely to encounter something they’re not prepared for. Acknowledging that things might go wrong is really the first step in making sure they don’t.

So, how do you use that travel anxiety to prevent any major fumbles? Good question...

A little practical planning can help you avoid some of the most common anxiety-provoking travel scenarios. Here are a few ideas, though it makes sense to focus on whichever parts of traveling always leave you harried and wishing you could go back in time to avoid the problem at hand.

• If you always show up to your flight gate riiight as they’re closing the doors : Choose a specific goal you could only achieve in your wildest travel dreams, like having time to brew an espresso at home so you don’t have to spend money on airport coffee. With that goal in mind, set alarms to go off throughout the day of your departure and alert you to things like when you should be completely done packing (yes, even your toothbrush), when you need to order a ride to the airport, when you need to actually be in your ride to the airport, etc. This will help you pace yourself properly instead of coming out of a packing fugue and shrieking when you catch sight of a clock.

Be sure to build in a buffer so you’re still running ahead overall even you’re a little behind on the alarms. Also, make sure the alarm sound you choose is as soothing as possible, or even an energizing song to get you amped up for your trip. Basically, avoid the same blaring alert that rouses you for work every morning, which might make you even more stressed out.

• If you’re far too familiar with that panic-inducing “Wait, where’s my passport?!” moment : Always keep your identification in the exact same holder or pouch in the same spot in your home when you’re not traveling. Then make a rule, like, “No matter which purse I take to the airport, I’ll always put my passport in the inside pocket.” (Or, if you always take the same bag, designate a specific compartment for important documents.) Also, make a paper copy just in case you lose the real thing. You can even add a “girl, where’s your passport?” alarm to your phone, too.
• If you might as well be on Mars the second your GPS doesn’t work : Print a paper copy of the directions you’ll need to get from the airport to wherever you’re staying, make sure you have an up-to-date guidebook that includes detailed maps, or look up navigational phrases in the local language to ask for directions in case you can’t find something. (Or do all three.) You can even take screenshots of maps or directions on your phone in case you lose service.
• If you inevitably board a long train ride only to realize you left your headphones at home or your phone is dying, so you have no way to entertain yourself : Seriously, those phone reminders are golden. Set one, perhaps for the night before you leave, so you remember to charge all the necessary devices you’ll need for amusement during your trip, or to bring books and magazines.

While the specifics here vary based on exactly what increases your travel stress, you get the gist.

Cover things like:

• A few common phrases to help you get by in the local language
• If you need a visa
• If your passport’s expiration date is far enough away from when you’ll be traveling
• Where to exchange currency for the best rate
• What kind of electrical outlets people use there
• If drinking the tap water is basically begging the toilet gods to get diarrhea
• If tipping is customary or if you can save that money for things like souvenirs
• If your phone company will charge you the equivalent of your 401k to send texts, make calls, and upload travel photos to Instagram
• What, if any, kinds of scams people might commonly use with tourists
• The local emergency number, just in case

“Planning out this stuff ahead of time doesn’t come naturally to everybody,” Antony says, “but if [something happens], it can really make things a whole bunch easier.”

You know those nagging what-ifs about everything that could go wrong as you travel? Don’t simply run those stressful scenarios on a mental loop or try to block them out completely. “Keep that scene playing out until you’re in a safe place where you’re OK,” Ellen Hendriksen , Ph.D, a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders and author of How to Be Yourself, Quiet Your Inner Critic and Rise Above Social Anxiety , tells SELF.

For example, if you know the local cuisine is generally safe to eat and you really want to try it, but you’re going to skip because you’re terrified of getting sick, walk through the steps of what would happen if you caught a stomach bug . Maybe it would involve taking anti-diarrhea medications, which you could stock up on in advance so you can taste test with less risk. This even works if you’re nervous about getting really ill. “Picture yourself calling the hotel management and asking them to get [you] to a hospital. Then picture going to the hospital and getting medicine. Then picture calling relatives at home,” Hendriksen says, explaining that laying out steps in an exercise like this “can ease the anxiety of picturing that worst-case scenario.”

If you don’t consider yourself the best traveler, every time you make it through a trip (or don’t have to sprint through an entire concourse to get on your flight, or go out to dinner on your own and order in the local language) is a triumph. Each roadblock you successfully navigate proves you’re capable of getting through travel intact.

Instead of forgetting those moments, file them away with the intention of being able to recall them easily, or write them down in a notebook or on your phone. “You gather evidence that [traveling] isn’t dangerous, this situation isn’t scary, that it’s OK to be away from home,” Hendriksen explains. When you’re feeling like you really just cannot handle whatever situation you’re dealing with, you have proof that you’ve dealt with at least some kind of travel blunder in the past.

Doing this will also prepare you better for the next time because it’ll help you learn from your mistakes. “That’s a way to reframe some of these negative experiences,” Antony says. “It’s not a reason not to travel, it’s an opportunity to learn how to travel better.”

There’s normal stressing out about pretty realistic scenarios, like that you’ll miss your train because you always cut it too close. Then there’s irrational stressing out about things that are unlikely to happen, like a terrorist attack. It’s of course smart to do any research to make sure the places you go to and the activities you partake in are safe. But if your worries about some impending tragedy get in the way of fully enjoying your experience once you’ve taken all the necessary safety measures, your anxieties may be at least partially unfounded.

For many people, the key is to break down those outsized fears, examine them closely, and counter anxiety with facts, Hendriksen says. For example, if you’re headed to Rome and worrying about a terrorist attack, ask yourself what the odds actually are of it occurring, perhaps by thinking of how many times it’s actually taken place in the last five years, Hendriksen says. Take it further, too: Even if something terrible does happen in the area you’re traveling to, what are the chances of it taking place exactly when you’re in that specific dangerous spot? Pretty unlikely, right?

If it’ll help tame your anxiety, you can look at statistics to back this up. Looking at the numbers might reassure you of just how rare certain scary events—like terrorist attacks or mass shootings —really are. Of course, this isn’t a solution for everyone. You can know just how unlikely something is and still be afraid of it. That’s where preparation comes in, like knowing where to go or who to call if you do have an emergency.

As another way of examining your fears, Hendriksen recommends asking if you’d advise a friend not to go to Rome (or to avoid the tourist spots she desperately wants to see) because there could be a potential terrorist attack. “See if it sounds reasonable or a little bit ridiculous. If it makes you laugh, then maybe it’s something you don’t have to listen to,” Hendriksen says.

If none of this actually helps tame your travel anxiety, it might be time to see a mental health professional.

It’s important to seek help for your anxiety about traveling if it’s affecting your life. While some travel anxiety can be normal, planning ahead and trying to rationalize away your fears can only do so much if you have a clinical anxiety disorder (i.e., maybe not much at all).

There are two main factors to take into account when deciding whether to see someone about your travel anxiety, says Antony. The first is how much the anxiety interferes with your ability to travel. The second is how important traveling is to you. Is it something you really want to do more? Are you in a relationship with someone who loves traveling? Could you benefit career-wise from taking more work trips? Is your best friend’s destination wedding coming up?

If you want or need to travel for any reason but you can’t (or you physically can, but you can’t enjoy your time away) you’ll want to consider seeking treatment, Antony says. A therapist can help you work on coping strategies for dealing with anxiety , or potentially refer you to a psychiatrist to see if medication will help you fulfill your wanderlust with as little stress as possible.

• 6 Things Every College Student Should Know About Therapy
• I Have Depression and Anxiety. Please Stop Telling Me to ‘Go for a Run’
• This Is When to See a Mental Health Professional About Your Anxiety

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5 tips to ease pre-travel anxiety

Author: Cheryl Carmin, PhD

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• Try to figure out what it is about travel that is making you anxious. What are you saying to yourself? Can you identify your “What ifs?” Once you’re able to understand what you’re afraid of, ask yourself if the fear is realistic. Even if your worst-case scenario is something catastrophic, does the very small likelihood of its occurrence outweigh the severity?
• If you have traveled before, what has your experience been? Did any of the things you’re worrying about happen? If they did, how did you manage? There’s a good chance you’re not giving yourself credit for being an effective and resilient problem solver.
• Is the over-planning, list-making or other strategies really helping? Everyone has their own way of preparing for travel. Making others conform to your way may cause arguments with your traveling companions and more stress.
• Do you have strategies to help you to relax? Slow, paced breathing is one strategy that many people find to be effective. Try an app for your smart phone, or one of the free relaxation recordings available from Ohio State’s Center for Integrative Medicine that help you to restore your calm equilibrium.
• Don’t skip the self-care activities. Just because you may think you’re in a time crunch the week before a trip, build in time for exercise. Physical activity is a great way to manage stress. Pamper yourself. A haircut or a manicure may be an important part of your pre-travel preparation to help you de-stress.

What provokes anxiety differs from person to person. This is definitely not a ‘one size fits all’ phenomenon. It may be useful to separate out if you’re afraid of the act of traveling or the destination.

• Our mental health experts are here to help you. Learn more

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Travel Anxiety: Causes and Cures

Fact checked.

Micah Abraham, BSc

Last updated October 10, 2020

Many people dream of travel. But travel anxiety is also very common. Some people experience a significant amount of anxiety when they travel. Those with persistent generalized anxiety and panic attacks are also prone to travel anxiety simply because travel represents change and distance from comfort. Some people fear travel but are not completely aware of this fear because they avoid booking their ticket or come up with other excuses in order to not leave their homes.

Whatever the case, travel anxiety makes it much harder to travel, whether for work or pleasure. This article explores the concept of travel anxiety, providing tips and information regarding what you can do to reduce your fear.

Causes of Travel Anxiety

Travel anxiety is unlikely to have any single specific cause. Many people have travel anxiety their entire lives. Others may develop the anxiety either because of past experiences relating to travel which were anxiety provoking; and some seem to have travel anxiety for no apparent reason at all. Here are some examples of experiences that can lead to travel anxiety:

• Fear of Flying Probably the most common issue seen in those with travel anxiety is a fear of flying. This is a fairly common phobia that’s linked to various factors: the lack of control, the changes in air pressure, the general discomfort, and the turbulence. These can all contribute to a fear of flying, especially as you age1. Since travel often involves flight, it's not uncommon for these fears to interact with your ability to control your anxiety.
• Horror Stories Some people are influenced by the "worst case scenario" stories they hear on the news. You may not even realize you're influenced, but when you access news articles about kidnappings, injuries, and other accidents, it's easy to subconsciously associate travel with tragedy.
• Home Comfort Some people also develop a fear of being far from home, because their home is their source of comfort. It's very common in those with anxiety disorders involving panic attacks or agoraphobia, for example, because their home becomes associated with being safe. The idea of leaving their home for an extended period of time then becomes very stressful.
• Post Trip Worries You may not have travel anxiety before the trip, but you may find that you develop it during your trip. This type of anxiety can be due to any number of issues, including the stress of planning and organizing details upon your arrival, the possible discomfort of being in a new environment, the looming threat of jetlag and perhaps simple worries about not knowing where your nearest supermarket or pharmacy might be.

But this is just a simplified list. You may not even know the exact reasons why your travel anxiety developed. It is possible - and important - to understand what your specific worries are (we'll get to that in a moment), but it isn't always possible to know why you have those worries. Travel anxiety affects many people and it can have a disruptive influence on your life.

How to Overcome Travel Anxiety

Of course, knowing about the causes is only the first step. Ideally, you'll also want to learn how to overcome your travel anxiety. Consider the following tips and strategies to reduce your travel anxiety:

• Don't Avoid It If you want to travel or you have to travel, don't avoid buying the ticket and don't push back the date of the vacation. The act of avoiding something fearful actually increases future fear, because by pushing it back you've created what's known as "negative reinforcement." This means that it becomes more and more likely that you’ll deal with travel anxiety in future by simply avoiding the travel date. This also serves to strengthen the anxiety. If you really want to overcome your travel anxiety, you need to put yourself out there and not let yourself fall into the avoidance trap.
• Figure Out Your Fears While you may not be able to figure out the underlying cause of your fears, it’s a lot easier to identify what your fears are. Are you afraid of flying? Afraid of being away from home? Afraid of the stress of planning a vacation? Notice when you're feeling travel anxiety and write down the thought that's going through your mind at that point in time. Knowing your fears will give you an opportunity to evaluate them.
• Prepare in Advance Start your trip anxious, and you’re setting yourself up for a difficult journey. Do your best to pack, plan your mail, arrange for a friend to look after your home, etc., as far in advance as possible. That way, the time before your departure will not be quite as hectic. Have your entire tripped planned as best as you can too so that you're never worried about what you're doing once you arrive.
• Have Someone to Call at Home You may also want to consider having someone that you can call if you experience anxiety - like a friend or family member. Ask someone you know that will be around. Tell them you have travel anxiety and you want to know that they'd be available if you needed to call someone. Knowing that person is there can often be enough to lower your anxiety levels.
• Take Vacation Breaks If you find that your anxiety while on your trip is acting up, take a short break from your vacation. This might mean, for example, going for a massage and staying home to watch Netflix rather than going sightseeing. Don't try to relax and ride it out if you start to get anxious. Anxiety is the type of condition that is nearly impossible to "fight" because fighting it increases stress, which ultimately creates more anxiety.
• Plan an Empty First Vacation If you have a fear of traveling in general, make your first vacation something where the entire goal is to do nothing but get used to the idea of traveling. For example, catch a plane to a location near a beach, and spend each and every day just sitting on the beach relaxing. Alternatively, plan a vacation where you spend as much (or more) time relaxing as compared to sight-seeing and actively engaging. This can help you get used to the act of being on a vacation without the pressures that come from some of these trips.

Beyond these travel anxiety ideas, you'll also want to focus on reducing your overall anxiety. Anxiety is a cumulative disorder. When you experience anxiety in one area of your life, it can cause more anxiety in other areas of your life. If you have anxiety on a daily basis, reducing that anxiety will provide you with a powerful advantage when it comes to managing your anxiety on the whole.

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

Where can I go to learn more about Jacobson’s relaxation technique and other similar methods? – Anonymous patient

You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process. – Timothy J. Legg, PhD, CRNP

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The Subtle Signs You Have High-Functioning Anxiety

Anxiety and other mental health disorders in men are still largely stigmatized. Beyond first recognizing and identifying the condition, there are vital steps men can take.

MY LIFE IS a dichotomy, in that I’ve spent years in tae kwon do, love football and rodeos, but have an affinity for frozen yogurt and watching Netflix with a good cabernet and wood wick candles next to my cats, Thelma and Louise. I attribute my temperament to genes and California hippy tap water.

The origins of personal traits, to include anxiety, can be biological, environmental, or inadvertently “seed-planted” by anxious parents. Male anxiety (a.k.a., “manxiety”) is clinically contagious if you’re around it long enough. My dad, a manly victim of indecisiveness, often had me second-guessing my own life choices, or not making one at all. To this day, I’m often paralyzed by an Applebee’s lunch menu or a yellow traffic light.

Men are stalwarts of resolve with an uncanny ability to chug beer, char meat, and kill one another. We recognize that our cars and lawn mowers need tune-ups and diagnostic tests, but we rarely wash our feet in the shower, let alone visit a physician for our own check-ups—especially for anything regarding the brain. And when we don’t prioritize our own well-being, neither do others. If you’re a man with anxiety, however, the norms become skewed and irrational.

I grew-up a hypochondriac certain that every pain, rash, bump, or twitch was something malignant or terminal. I visited the hospital countless times per year while spending the equivalent of a Range Rover full of backup dancers on annual copays. What I thought was testicular cancer was an inguinal hernia from doing deadlifts. What I was certain was genital herpes was an ingrown hair. What I feared was Lyme disease was an allergic reaction to grass. And what I accepted as a heart attack turned out to be…anxiety.

Only twice did I not go to a hospital when I should have. The first was at 18 while suffering intense chest pains and labored breathing because I had unknowingly collapsed a lung. In my defense, I thought it was heartburn. The second was when I intermittently peed blood over a 10-month stint. A rational man would interpret hematuria as the ultimate motivation for a hospital visit. But the only thing worse than my fear of potential hospice was the anxiety of a pending cystoscopy.

Consequently, I settled on platinum-level denial until I landed in surgery and chemo. Ignorance is a prickly muse. With chronic male anxiety, it’s torturous to determine what warrants an ER visit versus antacids. And when it came to my mental health, I handled it like most men: denial, distraction, and drugs. In that order.

“Men are MUCH MORE STIGMATIZED by any admission of a psychiatric illness and are much LESS LIKELY TO SEEK TREATMENT .”

Most men with anxiety have no idea what’s wrong with them—like Bill Bixby in The Hulk, they just feel “off.” Denial and distraction are why so many men walk around as functioning alcoholics or addicts. In the absence of knowing any better or a willingness to seek help regarding male anxiety, we plug the holes however we can. But if you treated any other ailment by ignoring or avoiding it, the outcome would be similarly grim. You can ignore asthma and diabetes for a while too. But every disorder has its dues.

Since anxiety, depression, and all disorders of the mind are still largely stigmatized among men, my first coping tactic was denial, lest I appeared weak and vulnerable among my peers. “While some may consider this a stereotype—that men do not seek help for mental health issues—it is statistically correct…men are much more stigmatized by any admission of a psychiatric illness and are much less likely to seek treatment,” says Sammie LaMont Moss, M.D., a psychiatrist at Kaiser Permanente in Denver.

This is particularly troublesome as depression and anxiety in men are more likely to manifest in substance abuse and suicidal behavior. “We often see in the clinical setting that an attempt to address anxiety can manifest in different ways. For example, men will turn to substances like alcohol or cannabis for some immediate relief, which can cause long-term, harmful effects,” says Moss.

How Anxiety Presents in Men

I’M AN EXCEPTIONALLY kind and empathetic guy, but anxiety makes me irritable and angry. If I’m forced to socially interact or deal with a rude stranger, I become a chupacabra with a flashpoint of WD-40. I expend great effort trying to determine when I’m feeling anxious before it defaults to a felony persona. But distinguishing between anxiety and irritability requires Maharajah-level introspection.

“Due to the social pressure that men experience based on the unwritten rule that men are to be strong and in control at all times, anxiety is not easily identifiable in men, even if that man’s anxiety has reached overwhelming levels” says San Diego psychologist Bruce Thiessen, Ph.D. “Many of the symptoms may express somatically, in the form of medical problems or conditions, such as ulcers, back pain, hypertension, and the like,” he says.

Dustin Siegel, Psy.D., a Chicago-based clinical psychologist and founder of the LEAP Center for Anxiety, agrees. “A lot of men have been told their whole lives to ‘man up’ or ‘be tough.’ It’s hard for many men to talk to someone else about their vulnerabilities, and one of the paradoxical truths about mental health is that the more a person—male or female—tries to bottle-up their feelings, the more likely they are to develop a problem.”

If I simply ignored my feelings of angst, I could pretend anxiety didn’t exist for me. But denial wasn’t designed nor intended to work long term. And when denying anxiety exacerbated problems, I turned to distraction. Distraction is an effective but equally short-term, noncurative technique in countering stress or discomfort, in that it avoids addressing the core issue.

How Does Chronic Anxiety for Men Differ in Anxiety for Women?

“THE MOST OBVIOUS signs of male anxiety are the physical ones,” says Lindsay Israel, M.D., psychiatrist and chief medical officer at Success TMS. “Men might find themselves going to the emergency room or their primary care provider with complaints of chest pain, fearful they are having a heart attack,” adds Dr. Israel. As men, we need to save our hearts for red meat and breakups.

Though anxiety is an equal opportunist, Dr. Israel shares that “women are twice as likely to develop an anxiety disorder as compared to men, and women are more likely to seek help for their anxiety symptoms. Therefore, men are more likely to develop severe symptoms of anxiety and possibly develop an additional depressive disorder due to the lack of treatment intervention.”

Thiessen confirms this assertion adding that, “men are also more likely to become aggressive, and to develop problems in their relationships, due to dysfunctional ways of expressing their anxiety. Many men turn to drugs, alcohol, gambling, and personally destructive sexual addictions to relieve chronic stress through escape,” says Thiessen.

In my case, I wielded distraction like artillery over my physical well-being. I over-trained in the gym, over-ran the trails, and over-swam in the lap pool. But I also over-imbibed alcohol. Drinking to distract is a futile endeavor. I would later harm-reduce to cannabis edibles, tinctures, and vapes. And on a few occasions, I casually overdid those too. Overdosing on THC edibles leads to a nauseous, frenzied panic that is ruefully memorable, with a hangover that rivals what you’d experience if you sniffed kerosene.

So, What to Do With All This Male Anxiety?

MEN ARE FIXERS. We often try to fix things and people that aren’t broke. It’s important to note that acute anxiety that prompts us to do our taxes or flee a K-pop mob is healthy. Once it becomes long term or chronic, however, it’s detrimental to one’s physical and mental health.

“One of the best ways for a man to become comfortable with accepting that he has a mental health issue is to speak to other people,” says Moss. “Quite often a man will be surprised to learn how many other people are suffering similar difficulties. Finding out that you are not alone can go a long way to help normalize what you’re experiencing,” adds Moss. Anxiety doesn’t always love company, but it loves perspective.

Thiessen upholds this tenet. “Men need to feel accepted, and not judged, for showing both strength and weakness. Society might judge them; mental health providers will not,” he says. In almost every instance where I’ve revealed my anxiety struggles to another man, he has replied in commiseration with his own. It’s clearly indicative of the ratio and cross section of men silently suffering from anxiety.

You Don't Need a Panic Room; You Need a Panic Plan

THERE ARE SIMPLE and clinically effective things men can do to lower their anxiety:

• Talk to your primary care provider, who could potentially prescribe medication or refer you to other specialists who can help. “This is also an area where group therapy, segregated by gender, may help—particularly for men who are stigmatized and think they’re being seen as weak or as a victim. Learning what other men experience can help break that stigma,” highlights Moss.
• There are phone apps for anything from interpreting your dog’s barks, to fermenting mead in your man-shed, to treating your anxiety while preserving your privacy. Moss encourages his patients to leverage smart phone apps like Calm, myStrength, and Headspace. Digital therapeutics (DTx) are mainstream now.
• Biofeedback, medications such as SSRIs, SNRIs, and in more recent years, neuromodulation such as TMS (transcranial magnetic stimulation) are all effective options for treatment of anxiety disorders. “Typically, it is not any one modality that targets these symptoms for a person, it is more often a combination of various modalities that gives the most optimal results,” says Dr. Israel.
• Physical exercise is an exceptional way to relieve anxiety. “Exercise prevents an excessive buildup of cortisol in the body while increasing levels of epinephrine and norepinephrine, neurotransmitters that modulate anxiety and regulate mood and emotion, yielding a sense of peace of mind,” cites Thiessen. Hakuna masquata, fellow men. Moss suggests also integrating healthy lifestyle choices, nutritious eating, and limiting harmful substances like alcohol and cannabis along with your fitness plan.

More than just the “greatest hits” to contest male anxiety, this is my own triage to maintaining a career, relationships, and a life largely unfettered by the cerebral minesweeper of anxiety. Because there’s no place like “om.”

This article originally appeared in our Men's Health Aging Guide.

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Natural remedies for treating anxiety, when to seek professional help.

Anxiety is a word we all know — and a feeling most of us experience at some point in our lives. Its prominence has risen in our culture in the past years ( especially during the pandemic ), making anxiety disorders now the most common mental illness in the U.S. And while it can certainly feel lonely to have anxiety, you're definitely not alone: 40 million adults in the U.S. struggle with anxiety disorders every year.

“A lot of people struggle with some sort of anxiety — it’s very normal and common,” says licensed psychologist and health and wellness expert Rachel Goldman, Ph.D. , who takes a holistic approach to mental health. “Even Simone Biles stepped away [from gymnastics] to take care of herself and was able to come back so much stronger and make Olympic history, so let that be a message to us all that we need to do what’s best for us.”

While many people find relief through medications and professional therapy, you don’t have to start there. There are a slew of natural remedies that have been shown to possibly help decrease symptoms of anxiety — from herbal supplements to lifestyle changes — and one of these natural remedies might just help soothe your stress.

Here, we asked mental health experts to share some of their top natural remedies for anxiety.

Anxiety is the body’s natural response to stress and is actually a beneficial evolutionary trait, since it helps us protect ourselves in dangerous situations. But chronic or intense feelings of worry and fear can be signs you’re dealing with anxiety in a more serious way. High-functioning anxiety can manifest in a myriad of ways, including sleep problems , muscle tension, gastrointestinal issues, irritability, difficulty concentrating and even panic attacks. But the good thing is, there are lots of ways to help ease your anxiety, ranging from small daily-routine additions to altering your mindset.

Keep a consistent routine

One possible cause of anxiety is a lack of routine in your day-to-day life. “Creating structure to your day is going to make you feel more in control,” Dr. Goldman says. Dr. Goldman asks her patients to look at four key aspects of their daily routines: sleep, diet, movement and stress management . Consistency in these behaviors, like getting eight hours of sleep a night, eating a balanced diet, taking a walk once a day and practicing mindfulness before bed can help reduce anxiety.

Just breathe

It sounds simple, but focusing on your breath and practicing deep breathing exercises can calm you down both physically and mentally. A 2023 study found that d eep breathing exercises can control feelings of anxiety or panic by countering hyperventilation and lowering blood pressure. Regularly engaging in these exercises can have positive long-term effects on mental health as well. There are many deep breathing techniques to try, including the three-part breath, box breathing and Bahya Pranayama (yogic breathing).

Dr. Goldman recommends the 5-finger technique, especially for children with anxiety; put one hand out in front of you and trace it with your other hand, inhaling when you trace up the finger, and exhaling when you trace down the finger.

Nurture your gut health

Our gut health and our mental health are more intertwined than we might think. In fact, the gut microbiome impacts neurotransmitter function in the brain , which affects things like risk for depression, anxiety and other cognitive or mental health issues, found a study from 2024. Translation: Good gut health supports good mental health. How to nurture this crucial gut-brain connection? Cater to it daily by eating fiber-filled foods like fruits and veggies, nuts, beans and whole grains , says BreAnna Guan N.D. , a licensed naturopathic physician, as well as drinking lots of water and loading up on probiotics through yogurt, kefir or fermented foods.

Move around

Exercise is one of the biggest mitigators of anxiety, but don’t sweat at the thought of lifting weights or running sprints on a treadmill every single day to keep on top of it. I nstead, focus on getting some sort of movement every day, such as taking a walk outside or doing some stretching . Sometimes, when you have a lot of pent up anxiety and feel the need to get it out of your system, a higher intensity workout, like going for a run or doing some weight-work, can be beneficial. “Other times, people might feel out of control, like they need to reground themselves,” Dr. Goldman says, “and that would be the time to do a slower movement, like a yoga pose or meditation.”

Sip some chamomile tea

Chamomile, a widely recognized herbal remedy, is known for its calming effects, and these days, chamomile tea is pretty ubiquitous. Study after study has found an abundance of evidence that chamomile may help improve anxiety symptoms , not only in people with diagnosed anxiety disorders, but in those with mild symptoms of anxiety as well.

Look into lavender and other herbs

Dr. Guan recommends a few other herbal remedies along with chamomile. She likes lavender for its calming quality that helps with sleep; she blends culinary lavender flowers into smoothies and suggests diffusing it to quiet your mind before bed.

Another stress-relieving herb whose popularity has been on the rise in the past few years is ashwagandha, which may help balance stress hormones and thyroid function , and can be taken as a capsule, gummy or powder mixed into a beverage. “It’s energizing and balancing without being stimulating,” Dr. Guan says. She also recommends schisandra berry an adaptogenic herb that may also help modify cortisol (our main stress hormone) response in stressful situations to help us stay calmer.

Keep a journal

There are lots of different ways to journal. You may have watched satisfying videos of someone filling out a bullet journal or heard about keeping a gratitude journal . But if you’ve never kept a journal before and are wondering where to start, Dr. Goldman recommends doing what she calls a “brain dump.” It is what it sounds like — a way to get all your racing thoughts out of your head and onto a piece of paper. “Don’t censor it, just write all those thoughts. Many times those thoughts keep hitting repeat until we do something about it,” she says. If you’re looking for a more guided type of journaling, Dr. Goldman recommends picking one journal prompt each day and responding to it.

Ground yourself with the 3-3-3 rule

Much of the time, anxious thoughts center around things that we can’t control, like the “would’ve, could’ve, should’ves” of the past. But if we turn our focus to the present, it helps ease that anxiety, Dr. Goldman explains. One way to focus on the here and now is to try a grounding exercise, like the 3-3-3 rule. It’s simple: All you have to do is focus on one thing you can see, one you can hear, and one you can touch right now. “Remind yourself of where you are,” Dr. Goldman says. “Focus on what’s in your control.”

Find a fidget toy

There are hundreds of fidget toys to ease anxiety out there, from fidget spinners and stress balls to spinning jewelry and keychains. While they may look like toys for children, don’t discount their calming abilities. A 2023 study found that adults who wore fidget rings over the course of a week reported a reduction in anxiety and stress . “Fidget toys are helpful especially when you can’t necessarily escape the situation you’re in,” Dr. Goldman says. For example, if you’re in a meeting and can’t leave to take a walk, you can get some of your anxiety out by spinning a fidget ring or shaping putty.

Up your magnesium intake

Magnesium is a mineral that supports relaxation and reduces tension, but many people are lacking in it , Dr. Guan says. Not getting enough magnesium means you may feel tired, be less able to fend off illness and your cortisol levels may stay elevated after experiencing stress or anxiety since magnesium can help balance this stress hormone. If you can't get enough of the mineral through your meals (foods that are rich in it include green leafy veggies, beans and nuts and seeds), there are plenty of magnesium supplements to choose from nowadays, and you can also check out our list of the best supplements for anxiety for other beneficial vitamins and minerals.

Top Magnesium Supplements, Vetted by Nutritionists

Nature Made Magnesium Glycinate 200 mg

NOW Magnesium 400 mg

Life Extension Neuro-Mag Magnesium

Snuggle under a weighted blanket.

Another stress-reducing product that has been gaining popularity in the past few years is the weighted blanket . It works by exerting deep pressure on the user, which is thought to release serotonin, a chemical in the body that makes you feel happy and calm. “Weighted blankets are a form of grounding yourself , like having a hug. T he pressure can calm you down ,” Dr. Goldman says, noting that weighted blankets can be especially helpful for people who find focusing on their breath to be more stressful than helpful.

It’s said that the people who don’t have time for meditation are the ones who need it the most. Whether you’re a mindfulness pro or someone who finds the idea of sitting alone with your thoughts boring or even painful, there’s a meditation practice out there for you. Check out our guide on how to meditate for anxiety for some general pointers, or try out a meditation app .

Try a cold plunge

You might have heard of cold plunges as a new wellness trend, and there’s science behind how taking the plunge may help ease anxiety through boosting feel-good chemicals like dopamine and other endorphins. But if soaking in ice isn't your style, you can still reap the chill-out benefits without fully submerging yourself — simply splashing cold water on your face or neck, or holding an ice cube could help. “It comes from this idea of shocking your body and telling it to do something else,” Dr. Goldman says. If you’re stressed or anxious on the physiological level, you might be sweating, or your heart might be racing, and putting cold water on your face can kickstart a change in these symptoms through activating your parasympathetic nervous system.

Hum along to the music

Here's one anxiety-tamer that you might already do quite often, without even realizing it: Humming along to a tune. “ Humming activates the parasympathetic nervous system and can slow down your stress response , so that is a unique thing that is easy to incorporate to manage the symptoms of anxiety while you’re having them,” says Dr. Guan.

More research on humming for stress or anxiety relief is needed, but one recent small study found that the practice appeared to have a positive affect on stress ; humming may also increase attention and improve sleep quality.

While these natural remedies can certainly help ease anxiety in the moment, seeing a therapist or talking to a psychiatrist about whether medication could help may be necessary if you're experiencing constant or severe anxiety. If your symptoms are impacting your quality of life so much that you aren’t able to carry out your daily tasks, or if your social and professional relationships are being impacted, or if your anxiety feels all consuming, it might be time to seek professional help.

“Natural things can be really nice to experiment with and explore at home with a low level of anxiety, but if your anxiety is prohibiting your normal activity, I’d start with [seeking professional help] and then working backwards and incorporating those natural lifestyle things,” says Dr. Guan.

Dr. Goldman also stresses the value of seeking professional help in more extreme cases and notes that there are some anxiety medications that are “take as needed” as opposed to medications that need to be taken everyday, which can be helpful for people who are worried about committing to a medication regimen.

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Anxiety and Older Adults: A Guide to Getting the Relief You Need

Related Topics

• Behavioral Health for Older Adults
• Depression & Anxiety for Older Adults

Anxiety is a natural response to many life stressors, such as meeting new people, speaking in public, or getting lost in an unfamiliar environment. But when those feelings of nervousness become overwhelming and make everyday life more difficult, it may be a sign of an anxiety disorder. Anxiety disorders affect nearly 4% of older adults worldwide 1 —and those are only the cases that are recognized and diagnosed.

What are the symptoms of an anxiety disorder?

Symptoms of anxiety vary from person to person. But in general, mental and behavioral signs of an anxiety disorder include:

• Uncontrollable feelings of panic, fear, and/or apprehension
• Obsessive thoughts
• Reactions that are disproportional to the triggering fear
• Restlessness
• Trouble with memory and focus
• Refusal to engage in routine activities
• Ritualistic behaviors (e.g., repeated handwashing)

Anxiety is often accompanied by physical signs such as:

• Racing heart, or heart palpitations
• Hot flashes
• Frequent urination
• Shortness of breath
• Tense muscles
• Excessive sweating
• Cold or sweaty hands

While symptoms are an important aspect of diagnosing anxiety in older adults, even more critical is how these symptoms affect day-to-day living. Anxiety is considered problematic when it interferes with your daily functioning, your quality of life, and even your health.

What is the most common anxiety disorder in older adults?

Generalized Anxiety Disorder (GAD) is believed to be the most common anxiety disorder among older adults . People who have GAD find themselves constantly worrying about many things. They fear the worst in every situation, even if that fear is unfounded. Adults suffering from GAD may feel like they're always on edge and in a high state of alert. They may understand that their nervousness is excessive but feel a lack of control over their emotions. General Anxiety Disorder tends to be more common among older women compared to older men, particularly in the event of divorce, separation, or the loss of a spouse or partner.

Other types of anxiety disorders affecting older adults include:

• Social anxiety disorder: Adults with social anxiety feel extreme nervousness and self-consciousness in everyday scenarios involving other people. They fear judgement from others and worry they'll do something to embarrass themselves. They may actively avoid social situations and have a hard time making and maintaining friendships.
• Phobia: If a person has an extreme, debilitating fear of something that does not pose a major threat—and this fear leads to avoidance of specific situations or objects—it's called a phobia. Some common phobias include dental procedures, the outside world (agoraphobia), heights, insects, thunderstorms, and driving a vehicle.
• Obsessive-compulsive disorder (OCD): Older adults with OCD struggle with unwanted, recurring thoughts or compulsions. They often feel that by performing certain actions repeatedly (e.g., counting the number of tiles on the floor), they will be able to feel a sense of control. Intrusive disturbing thoughts, like being injured in a car accident, are also a form of OCD.

What are some causes of anxiety in older adults?

Anxiety doesn’t always have a specific cause, and scientists aren’t completely clear why some adults suffer from excessive anxiety. It’s possible that multiple situational and environmental triggers are at play. Some common risk factors for anxiety disorders in seniors include:

• Stressful life events (e.g., death of a loved one )
• Limited physical mobility
• Loss of independence
• Financial insecurity
• Sleep disturbances (e.g., insomnia )
• Chronic health conditions (e.g., diabetes, obesity )
• Side effects of medications (e.g., steroids, stimulants)
• Misuse / abuse of alcohol or prescription medications
• Trauma from childhood

There may also be physiological risk factors for anxiety disorders in older adults. Some people have a chemical imbalance brought on by extreme stress. Anxiety may also run in families. For example, if your mother had GAD, you’re at greater risk for developing it, too.

If your anxiety is having a negative impact on your life, it's time to speak to your healthcare provider. They'll likely start with a complete physical exam to help rule out any potential medical causes of your symptoms. If there are no signs of physical illness, your provider may refer you to a licensed mental health counselor, psychologist, or psychiatrist. These professionals are specially trained to diagnose anxiety, depression, and other mental health disorders through interviews and other assessment tools.

How do you treat severe anxiety in older adults?

Too many older adults neglect to seek help for their anxiety due to shame and a lack of understanding about mental illness. That’s why it’s important to know that an anxiety disorder is not something you can control or will away. It’s considered a chronic health condition that requires medical treatment, just like diabetes or high blood pressure. Anxiety disorders are generally treated using talk therapy, medication, or a combination of both.

• Talk therapy (also called psychotherapy or counseling) is conducted one-on-one with a therapist or counselor. Many anxiety sufferers benefit from a type of therapy called exposure therapy. It involves tackling your fears head-on in order to become more comfortable with those activities or objects. Cognitive behavioral therapy (CBT) is another therapeutic approach used with anxiety disorders. CBT helps you identify harmful, anxiety-provoking thought patterns and work on changing them.
• Prescription medications can help alleviate feelings of panic or nervousness and allow you to function more normally. Some of the medications used to relieve anxiety include anti-anxiety medications (e.g., benzodiazepines) and antidepressants. Beta blockers, normally used to treat hypertension, have been found to be helpful in reducing some of the physical manifestations of anxiety.

How can older adults manage anxiety?

Seeking medical intervention should be a priority if your anxiety exceeds typical, everyday worries. But there are also lifestyle practices you can adopt to make your anxiety more manageable:

• Talk it out: Oftentimes, sharing our feelings and experiences can help us feel less anxious. Consider joining an online or in-person support group for those with anxiety disorders, or talk with a trusted friend, family member, or spiritual leader.
• Manage your stress: Meditation, yoga, mindfulness , deep breathing, and other stress management techniques can help relieve the physical symptoms of anxiety and make you feel more relaxed.
• Avoid stimulants: Certain substances can worsen anxiety disorder symptoms. These include caffeine, nicotine, over-the-counter cold medications, alcohol , and certain herbal supplements.
• Get plenty of sleep: A study by University of California, Berkeley researchers showed that sleeplessness can increase anxiety by up to 30% the next day. 2 Older adults should aim to get 7 to 9 hours of sleep per night.

Severe anxiety is not a normal part of aging—and you don’t have to accept living with it. If excessive worry is keeping you from a happy and productive life, talk to your doctor. Today’s anxiety treatments are safe and effective and can help you feel like yourself again.

Learn more about mental health for older adults and take an anxiety screening.

1. Mental health of older adults, World Health Organization. Found on the internet at https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults

2. Overanxious and underslept, Nature Human Behavior. Found on the internet at: https://www.nature.com/articles/s41562-019-0754-8

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The Real Reason for Travel Anxiety

10 anxiety hacks to lower your travel stress..

Posted September 19, 2022 | Reviewed by Gary Drevitch

• What Is Anxiety?
• Take our Generalized Anxiety Disorder Test
• Find counselling to overcome anxiety
• Now more than ever, air travel has become an anxious mindscape.
• Airlines profit from creating customer anxiety.
• There are tactics you can employ to preserve your mental well-being in transit.

The airport is an unruly place. It’s opposite world. People who otherwise rarely move are seen sprinting to Cinnabon. High fashion is Birkenstocks and yoga pants. Happy hour starts at 7:00 am. Stepping over sleeping adults in fetal positions is expected. And all purchases are made within a 400% inflationary market.

The Boarding Process: Humanity Has Left the Building

In few other affairs is your life status so publicly displayed than during the airline boarding process. This is by design. Airlines publicly grade us by airport megaphone. It’s a grandstand to reward or humble customers based on how much money those individuals have we spend with them. The airline credo? “If you want to travel humanely, you’re going to pay.”

All airlines do the same thing: They move people from one place to another via the troposphere. The way in which they begin their process, however, can greatly vary, with the differences most evident during onboarding.

As soon as the gate attendant blows into a hot mic, people leap to their feet into pole position, blocking all pathways to the jetway ready to blitz the ticket scanner. There are notable reasons we act like stressed Billy goats during the boarding process, including the following:

• Mob Mentality. A study found that as few as five people can influence a crowd of 100 to follow suit. 1 At the gate we leave our common sense to follow these Pied Pipers to a closed, retractable belt barrier 12 feet away, where we wait for the next gate announcement.
• Competition . We want to be the first on and the first off the plane. It's why people jockey for the airplane aisle as soon as the seatbelt sign dings off. God forbid if a senior citizen or toddler tries to disembark first. It often becomes every passenger for him/herself, as if airports and planes are vacuums of courtesies.

Impatience . People crowd the gate under the illusion that it will get them to their destination faster. A superior use of time would be to find nearby space and do some birthing squats and jumping jacks to avoid the onset of DVT.

Baggage space . Planes almost always have enough overhead bin space for every passenger. In fact, newer planes have increased bin space. 2 Yet people will still drop their bags on unsuspecting heads.

California-based clinical psychologist Tom McDonagh says, “There has been a measurable uptick in clients who divulge anxiety about travel. Oftentimes clients will express worrisome thoughts about what could go wrong on their flight." These types of cognitive distortions are "future tripping" thoughts. "Get into the habit of seeing anxious thoughts as a symptom, and not reality, to help alleviate your stress," adds McDonagh.

Why Can’t the Airlines Lose My Emotional Baggage?

The airlines employ the art of anxiety seed-planting so you’ll pay a little more to check your bags or opt for earlier boarding. In their defense, airline margins are small and they depend on such fees to remain profitable. In 2021, airlines in the U.S. made an estimated $4.3 billion in baggage fees alone. The scariest thing about flying today are those fees. Which begs the question: "Is that a bag you’re checking, or a griefcase?"

To maximize profits, airlines create the illusion of grossly limited bin space, while continuing to splice boarding groups into ever-thinner stratifications. Consider the many tiers of the boarding processes to understand the psychological game you’ve entered. United boards in six groups, American has nine, and Delta has 10. You board according to your value to the airline.

I ride “basic economy” — the airborne proletariat class. We roll onto the jet bridge like the end credits of a sad movie. Airline personnel avoid making eye contact with us, knowing we barely chipped in for gas. Our shame is palpable. In the future, airlines could operate under any array of boarding and seating procedures, such as including bleachers or removing the seats and tethering each of us to a standing pole. But rest easy, Marco Polo, there are strategies to quell your travel angst.

10 Tactics to Less Stressful, if Not Stress-Free Travel

• Counter the murmuring lies of anxiety . "Some people are struggling intensely with 'contamination anxiety.' They're worried about catching Covid on a plane," McDonagh says. "We try to help these clients by discussing possibility versus probability. When it comes to fear , we often overassume but just because something is possible, does not mean it's probable."
• Practice makes progress . Build up your safe-risk tolerance prior to travel day to develop resiliency for the unfamiliar. Think overnight or weekend daytrip, not Burning Man. The goal is to not make your upcoming trip the first big, new experience since Covid and Zoom.
• Bring a “bug-out” bag . Include all the travel-soothing accoutrements you need for your mental and physical well-being. These might include books, electronics, snacks, medications, that silly neck pillow, and the contact information of those in your support circle.
• Consider avoiding caffeine and alcohol . Both can leave you feeling dehydrated in a desiccating fuselage. Moreover, they can both increase anxiety. Anxiety kicks in with caffeine, booze, and no control over the window shade.

Normalize feeling abnormal . Remind yourself that it is 100% normal to have worries or stress related to travel. While this skill might seem overly simplistic, it’s incredibly powerful. Telling yourself, “It makes sense that I feel this way given the situation,” is often the reassurance your brain needs. Normalize and nama-stay who you are.

Name it to tame it . Labeling emotions is a proven way to reduce their intensity. This process uses your prefrontal cortex, which brings your more reasonable, thoughtful self back online. It can downregulate the anxiety center of the brain that contributes to stress. Do this by asking yourself, “At this moment, how am I feeling given this situation?” Talking to yourself is a sign of higher intelligence — especially when referring to yourself in the third person. 3 But use a sock puppet if you want to make a statement.

Breathing . An effective way to flip from fight-or-flight response to the rest-and-digest state is by doing the physiological sigh. 4 Take a short inhale through your nose, pause for a moment, and then inhale through your nose again. Then slowly exhale through your mouth. It’s a process our bodies do naturally when soothing from an emotional experience. Imagine a young child or politician at the end of a crying fit and you can see the double intake that naturally happens. Take 5-10 physiological sighs as needed.

Progressive Muscle Relaxation (PMR) . Muscle tension contributes to stress. To reduce muscle tension, intentionally constrict your muscles for 30-60 seconds. This constriction causes the muscle to be less tense after the constriction period. Try to focus on one muscle group at a time while seated, such as your feet/lower legs and work your way up the body. Flying Frankie says relax.

Acceptance . Acceptance does not mean approval. Simply acknowledge things as they are in the moment. Boarding delays, limited leg space, and lavatory lines will likely be part of the experience. Acceptance removes unnecessary suffering. Acceptance challenge accepted!

Don’t fall asleep before the snack cart reaches your row.

If anyone is Christmas shopping for me, I’m a size “window seat.”

University of Leeds. 2008, February 16. Sheep In Human Clothing: Scientists Reveal Our Flock Mentality. ScienceDaily

McCartney, Scott - "Travelers, Welcome to the Revolution in Overhead Bin Size," The Wall Street Journal, October 13, 2021

Kross, E., Bruehlman-Senecal, E., Park, J., Burson, A., Dougherty, A., Shablack, H., Bremner, R., Moser, J., & Ayduk, O. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304–324

Ramirez J. M. (2014). The integrative role of the sigh in psychology, physiology, pathology, and neurobiology. Progress in brain research, 209, 91–129.

Jon Patrick Hatcher, M.A., is the author of 101 Ways to Conquer Teen Anxiety and Anxiety Hacks for an Uncertain World.

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What is separation anxiety?

• How to ease "normal" separation anxiety

What is separation anxiety disorder?

Symptoms of separation anxiety disorder, common causes, helping a child with separation anxiety disorder, easing separation anxiety: tips for school, help your child by relieving your own stress, when to seek professional help, separation anxiety and separation anxiety disorder.

If your child's anxieties get in the way of school or other activities, these steps can help to make the separation process easier.

It’s natural for your young child to feel anxious when you say goodbye. In early childhood, crying, tantrums, or clinginess—all the hallmarks of separation anxiety—are healthy reactions to separation and a normal stage of development. It can begin before a child’s first birthday and may reoccur until the age of four. While the intensity and timing of separation anxiety can vary tremendously from child to child, it’s important to remember that a little worry over leaving mom or dad is normal, even when your child is older. With understanding and the right coping strategies, your child’s fears can be relieved—and should fade completely as they get older.

However, some children experience separation anxiety that doesn’t go away, even with a parent’s best efforts. These kids experience a continuation or reoccurrence of intense separation anxiety during their elementary school years or beyond. If separation anxiety is excessive enough to interfere with normal activities like school and friendships, and lasts for months rather than days, it may be a sign of a larger problem: separation anxiety disorder .

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How to ease “normal” separation anxiety

For children with normal separation anxiety, there are steps you can take to make the process of separation anxiety easier.

Practice separation. Leave your child with a caregiver for brief periods and short distances at first. As your child gets used to separation, you can gradually leave for longer and travel further.

Schedule separations after naps or feedings. Babies are more susceptible to separation anxiety when they’re tired or hungry.

Develop a quick “goodbye” ritual. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss. Keep things quick, though, so you can:

Leave without fanfare. Tell your child you are leaving and that you will return, then go—don’t stall or make it a bigger deal than it is.

Follow through on promises. For your child to develop the confidence that they can handle separation, it’s important you return at the time you promised.

Keep familiar surroundings when possible and make new surroundings familiar. Have the sitter come to your house. When your child is away from home, encourage them to bring a familiar object.

Have a consistent primary caregiver. If you hire a caregiver, try to keep them on the job long term to avoid inconsistency in your child’s life.

Minimize scary television. Your child is less likely to be fearful if the shows you watch are not frightening.

Try not to give in. Reassure your child that they will be just fine—setting consistent limits will help your child’s adjustment to separation.

Separation anxiety disorder is NOT a normal stage of development, but a serious emotional problem characterized by extreme distress when a child is away from the primary caregiver. However, since normal separation anxiety and separation anxiety disorder share many of the same symptoms, it can be confusing to try to figure out if your child just needs time and understanding—or has a more serious problem.

The main differences between normal separation anxiety and separation anxiety disorder are the intensity of your child’s fears, and whether these fears keep them from normal activities. Children with separation anxiety disorder may become agitated at just the thought of being away from mom or dad, and may complain of sickness to avoid playing with friends or attending school. When symptoms are extreme enough, these anxieties can add up to a disorder. But no matter how fretful your child becomes when parted from you, separation anxiety disorder is treatable. There are plenty of things you can do to make your child feel safer and ease the anxiety of separation.

Kids with separation anxiety disorder feel constantly worried or fearful about separation. Many kids are overwhelmed with symptoms such as:

Fear that something terrible will happen to a loved one. The most common fear a child with separation anxiety disorder experiences is the worry that harm will come to a loved one in the child’s absence. For example, the child may constantly worry about a parent becoming sick or getting hurt.

Worry that an unpredicted event will lead to permanent separation. Your child may fear that once separated from you, something will happen to maintain the separation. For example, they may worry about being kidnapped or getting lost.

Refusal to go to school. A child with separation anxiety disorder may have an unreasonable fear of school, and will do almost anything to stay home.

Reluctance to go to sleep. Separation anxiety disorder can make children insomniacs , either because of the fear of being alone or due to nightmares about separation.

Physical sickness like a headache or stomach pain. At the time of separation, or before, children with separation anxiety problems often complain they feel ill.

Clinging to the caregiver. Your child may shadow you around the house or cling to your arm or leg if you attempt to step out.

Separation anxiety disorder occurs because a child feels unsafe in some way. Take a look at anything that may have thrown your child’s world off balance, made them feel threatened, or upset their normal routine. If you can pinpoint the root cause—or causes—you’ll be one step closer to helping your child through their struggles.

Common causes of separation anxiety disorder in children include:

Change in environment. Changes in surroundings, such as a new house, school, or day care situation, can trigger separation anxiety disorder.

Stress. Stressful situations like switching schools, divorce, or the loss of a loved one—including a pet—can trigger separation anxiety problems.

Insecure attachment. The attachment bond is the emotional connection formed between an infant and their primary caretaker. While a secure attachment bond ensures that your child will feel secure, understood and calm enough for optimal development, an insecure attachment bond can contribute to childhood problems such as separation anxiety.

[Read: Attachment Issues In Children]

An overprotective parent. In some cases, separation anxiety disorder may be the manifestation of your own stress or anxiety. Parents and children can feed one another’s anxieties.

Separation anxiety or trauma?

If it seems like your child’s separation anxiety disorder happened overnight, the cause might be something related to a traumatic experience rather than separation anxiety. Although these two conditions can share symptoms, they are treated differently. By understanding the effects of traumatic stress on children , you can help your child benefit from the most fitting treatment.

None of us like to see our children in distress, so it can be tempting to help your child avoid the things they’re afraid of. However, that will only reinforce your child’s anxiety in the long term. Rather than trying to avoid separation whenever possible, you can better help your child combat separation anxiety disorder by taking steps to make them feel safer. Providing a sympathetic environment at home can make your child feel more comfortable. Even if your efforts don’t completely solve the problem, your empathy can only make things better.

Educate yourself about separation anxiety disorder. If you learn about how your child experiences this disorder, you can more easily sympathize with their struggles.

Listen to and respect your child’s feelings. For a child who might already feel isolated by their disorder, the experience of being listened to can have a powerful healing effect.

Talk about the issue. It’s healthier for children to talk about their feelings—they don’t benefit from “not thinking about it.” Be empathetic, but also remind your child—gently—that they survived the last separation.

[Read: How to Stop Worrying]

Anticipate separation difficulty. Be ready for transition points that can cause anxiety for your child, such as going to school or meeting with friends to play. If your child separates from one parent more easily than the other, have that parent handle the drop off.

Keep calm during separation. If your child sees that you can stay cool, they are more likely to be calm, too.

Support the child’s participation in activities. Encourage your child to participate in healthy social and physical activities. They’re great ways to ease anxiety and help your child develop friendships.

Praise your child’s efforts. Use the smallest of accomplishments—going to bed without a fuss, a good report from school—as reason to give your child positive reinforcement.

Tips for helping your child feel safe and secure

Provide a consistent pattern for the day. Routines provide children with a sense of security and help to eliminate their fear of the unknown. Try to be consistent with mealtimes, bedtimes and the like. If your family’s schedule is going to change, discuss it ahead of time with your child. Change is easier on kids if it’s expected.

Set limits. Let your child know that although you understand their feelings, there are rules in your household that need to be followed. Like routines, setting and enforcing limits helps your child know what to expect from any given situation.

Offer choices. If your child is given a choice or some element of control in their interaction with you, they may feel more safe and comfortable. For example, you can give your child a choice about where at school they want to be dropped off or which toy they want to take to daycare.

For children with separation anxiety disorder, attending school can seem overwhelming and a refusal to go is commonplace. But by addressing any root causes for your child’s avoidance of school and by making changes at school, though, you can help reduce your child’s symptoms.

Help a child who has been absent from school return as quickly as possible. Even if a shorter school day is necessary initially, children’s symptoms are more likely to decrease when they discover that they can survive the separation.

Ask the school to accommodate your child’s late arrival. If the school can be lenient about late arrival at first, it can give you and your child a little wiggle room to talk and separate at your child’s slower pace.

Identify a safe place. Find a place at school where your child can go to reduce anxiety during stressful periods. Develop guidelines for appropriate use of the safe place.

Allow your child contact with home. At times of stress at school, a brief phone call—a minute or two—with family may reduce separation anxiety.

Send notes for your child to read. You can place a note for your child in their lunch box or locker. A quick “I love you!” on a napkin can reassure a child.

Provide assistance to your child during interactions with peers. An adult’s help, whether it is from a teacher or counselor, may be beneficial for both your child and the other children they’re interacting with.

Reward your child’s efforts. Just like at home, every good effort—or small step in the right direction—deserves to be praised.

Kids with anxious or stressed parents may be more prone to separation anxiety. In order to help your child ease their anxiety symptoms, you may need to take measures to become calmer and more centered yourself.

Talk about your feelings. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation.

Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress.

Eat right. A well-nourished body is better prepared to cope with stress, so eat plenty of fruit, vegetables, and healthy fats, and try to avoid junk food, sugary snacks, and refined carbohydrates.

Practice relaxation. You can control your stress levels with relaxation techniques like yoga, deep breathing, or meditation.

Get enough sleep. Feeling tired only increases your stress, causing you to think irrationally or foggily, while sleeping well directly improves your mood and the quality of your waking life.

Keep your sense of humor. As well as boosting your outlook, the act of laughing helps your body fight stress in a variety of ways.

Your own patience and know-how can go a long way toward helping your child with separation anxiety disorder. But some kids with separation anxiety disorder may need professional intervention. To decide if you need to seek help for your child, look for “red flags,” or extreme symptoms that go beyond milder warning signs. These include:

• Age-inappropriate clinginess or tantrums.
• Withdrawal from friends, family, or peers.
• Preoccupation with intense fear or guilt.
• Constant complaints of physical sickness.
• Refusing to go to school for weeks.
• Excessive fear of leaving the house.

If your efforts to reduce these symptoms don’t work, it may be the time to find a mental health specialist. Remember, these may also be symptoms of a trauma that your child has experienced . If this is the case, it is important to see a child trauma specialist.

Child psychiatrists, child psychologists, or pediatric neurologists can diagnose and treat separation anxiety disorder. These trained clinicians integrate information from home, school, and at least one clinical visit in order to make a diagnosis. Keep in mind that children with separation anxiety disorder frequently have physical complaints that may need to be medically evaluated.

Specialists can address physical symptoms, identify anxious thoughts, help your child develop coping strategies, and foster problem solving. Professional treatment for separation anxiety disorder may include:

Talk therapy. Talk therapy provides a safe place for your child to express their feelings. Having someone to listen empathetically and guide your child toward understanding their anxiety can be extremely helpful.

Play therapy. The therapeutic use of play is a common and effective way to get kids talking about their feelings.

Counseling for the family. Family counseling can help your child counteract the thoughts that fuel their anxiety, while you as the parent can help your child learn coping skills.

School-based counseling. This can help your child with separation anxiety disorder explore the social, behavioral, and academic demands of school.

Medication. Medications may be used to treat severe cases of separation anxiety disorder. It should be used only in conjunction with other therapy.

Hotlines and support

Call the National Parent Helpline  at 1-855-427-2736 or the  NAMI Helpline  at 1-800-950-6264 (National Alliance on Mental Illness).

Call the  Family Lives Helpline  at 0808 800 2222 or  Anxiety UK  at 03444 775 774.

Call the  Parentline  at 1300 30 1300 or the  SANE Help Centre  at 1800 18 7263.

Call the Parent Helpline at 1-888-603-9100 or visit Anxiety Canada  for links to services in different provinces.

More Information

• Separation Anxiety - Practical coping suggestions for parents. (KidsHealth)
• School Refusal - Describes the symptoms and what parents can do about the problem. (Anxiety and Depression Association of America)
• Schneider, S., Blatter-Meunier, J., Herren, C., Adornetto, C., In-Albon, T., & Lavallee, K. (2011). Disorder-Specific Cognitive-Behavioral Therapy for Separation Anxiety Disorder in Young Children: A Randomized Waiting-List-Controlled Trial. Psychotherapy and Psychosomatics, 80(4), 206–215. Link
• Craske, M. G., & Stein, M. B. (2016). Anxiety. Lancet (London, England), 388(10063), 3048–3059. Link
• Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. Link
• Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice – a systematic review and meta-analysis. BMC Health Services Research, 18(1), 559. Link
• Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018). Moving to Beat Anxiety: Epidemiology and Therapeutic Issues with Physical Activity for Anxiety. Current Psychiatry Reports, 20(8), 63. Link
• Anxiety Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link

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FDA Clears First Digital Therapeutic for Treatment of Generalized Anxiety Disorder

DaylightRX from Big Health is a digital formulation of cognitive behavioral therapy and is available by prescription only.

The FDA has granted clearance to the digital therapeutic DaylightRX for the treatment of generalized anxiety disorder (GAD) as an adjunct to usual care in patients aged 22 years and older, Big Health announced in a release. 1 The therapy is the first digital treatment approved to treat GAD in the United States.

FDA Clears First Digital Therapeutic for Treatment of Generalized Anxiety Disorder / Tada Images - stock.adobe.com

DaylightRX is a digital formulation of cognitive behavioral therapy (CBT) and includes lessons that teach patients different evidence-based techniques to help reduce chronic worry and anxiety, including applied relaxation, stimulus control, cognitive restructuring, and exposure therapy. The therapy, which is available by prescription only, was developed based on Big Health’s existing digital care program Daylight.

READ MORE: Psilocybin Mushrooms: A Journey from Ancient Traditions to Modern Clinical Use

“I am thrilled to announce that we have secured a landmark clearance of DaylightRx for the treatment of generalized anxiety disorder,” Yael Berman, CEO of Big health, said in a post on LinkedIn. 2 “This is the first FDA cleared digital treatment for generalized anxiety disorder, paving the way for these accessible, effective treatments to support millions of patients worldwide.”

The clearance of DaylightRX was based on data from randomized controlled trials, including a randomized, partially blind, parallel-group, superiority phase 2 trial that evaluated the efficacy of Daylight compared with a waitlist control in individuals who had moderate to severe GAD symptoms. Findings from the study were published in the journal Depression and Anxiety . 3

The study cohort included 256 adult patients who randomly received either Daylight or were part of a control group. Patients in the treatment group received digital CBT therapy via an app on their own smartphone. The primary endpoint was GAD symptoms as measured by the GAD-7-item post-intervention. Key secondary endpoints included effects on worry, depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life.

Investigators conducted online assessments at baseline (week 0), mid-intervention (week 3), post-intervention (week 6), and follow-up (week 10). Patients in the intervention arm were also invited to complete a longer-term uncontrolled assessment at Week 26.

The study found that patients who received Daylight had significantly reduced anxiety symptoms at week 6 compared to the control group. At week 10, 71% of patients in the treatment group achieved remission of GAD, compared to 33% in the control group. The improvements in symptoms were seen to be sustained at week 26. The therapy also significantly improved measures of worry, depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life. 4

Daylight was safe and effective, with only 1 participant reporting an adverse event related to difficulty accessing the intervention. Patients in the treatment group reported significantly fewer occurrences of unwanted symptoms, including low mood, fatigue and/or exhaustion, extreme sleepiness, feeling agitated, difficulty remembering things, headache and/or migraine, difficulty concentrating and focusing on things, and reduced motivation and/or energy.

"For too long, patients seeking non-drug treatment options for anxiety have had limited choices,” Berman said in a release. 1 “Now, with our FDA-cleared treatment, we're offering a powerful alternative with remission rates of over 70 percent. With this clearance, there is now an accessible non-medication option that patients can trust.”

READ MORE:   Mental and Behavioral Health Resource Center

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our   free Drug Topics newsletter .

1. US FDA Grants Clearance for DaylightRx. News Release. Big Health. September 4, 2024. Accessed September 4, 2024. https://www.bighealth.com/news/us-fda-grants-clearance-for-daylightrx

2. yael berman linkedin page. i am thrilled to announce that we have secured a landmark clearance of daylightrx for the treatment of generalized anxiety disorder. this is the first fda cleared digital treatment for generalized anxiety disorder, paving the way for these accessible, effective treatments to support millions of patients worldwide. what is equally exciting is that this is the second fda clearance for big health in the past month—most recently, for sleepiorx to treat insomnia., for too long, patients seeking non-drug treatment options for anxiety have had limited choices. now, with our fda-cleared treatment, we're offering a powerful alternative with remission rates of over 70 percent. with this clearance, there is now an accessible non-medication option that patients and providers can trust., i want to credit our cmo, jenna carl, phd, for leading the big health team down the fda path, from establishing our strategy several years ago to achieving two successful fda clearances. additional acknowledgment to our world-class research and regulatory team, particularly tali ball, phd (daylightrx) and alasdair henry, phd (sleepiorx), who led and managed all aspects of the clinical trials and submissions, and reuben lawson for his deep regulatory expertise and guidance. and a big thank you to the many others who guided and supported this multi-year effort, including dani bradley, christopher b. miller phd, colin a. espie, peter hames, arun gupta, and anand shah, md. accessed september 4, 2024. https://www.linkedin.com/feed/update/urn:li:activity:7237106266165116928/, 3. carl jr, miller cb, henry al, davis ml, stott r, smits jaj, emsley r, gu j, shin o, otto mw, craske mg, saunders kea, goodwin gm, espie ca. efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: a randomized controlled trial. depress anxiety. 2020 dec;37(12):1168-1178. doi: 10.1002/da.23079. epub 2020 jul 29. pmid: 32725848., 4. landmark randomized controlled trial demonstrates efficacy of daylight™ digital therapeutic in improving anxiety. news release. big health. july 29, 2020. accessed september 4, 2024. https://www.bighealth.com/news/randomized-controlled-trial-demonstrates-efficacy-of-daylight-for-improving-anxiety.

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The invisible toll of life with polycystic ovary syndrome

The overlooked emotional and psychological effects of PCOS are creating a silent mental health crisis

O ne night in February, my husband and I were bickering about our car. He said something that pissed me off and I snapped like a worn out hair tie: I hollered absurd accusations, stormed up and down the stairs and ugly-cried until I was too tired to function. Though I knew I was being wild at the time, my emotions felt terminal.

The next morning I wrote in my journal, “Something is starting to shift with my mental health.” Throughout the entry, it’s clear I was confused and distraught. I pondered the same question ad nauseam: what is wrong with me?

Sitting on the toilet with blood-stained underwear around my ankles a couple of days later, I realized my outburst was fueled by particularly severe PMS. Over a decade earlier, I was diagnosed with Polycystic Ovary Syndrome (PCOS). People with the condition were born with ovaries and experience at least two of the three main diagnostic criteria : menstrual irregularities, elevated levels of androgens like testosterone and the presence of small follicles on the ovaries.

I’d lived most of my adult life with annoying but not debilitating symptoms: painful cramps, erratic pimples, maddening stretches of insomnia and PMS that mostly manifested as apathy.

Then, in October last year, I went off birth control to answer a question I commonly see in PCOS-related Reddit threads : am I even fertile? Without the NuvaRing’s regulating influence, my mood took a turn – plummeting into deep depression and bouts of irritability in the week before my period.

The mental health toll of PCOS

Though estimates vary, between 8 and 13% of menstruating adults have PCOS, and many experience adverse mental health outcomes. Recent studies have revealed that people with PCOS are four to seven times more likely to have depression and anxiety , three to six times more likely to have an eating disorder , and 8.47 times more likely to attempt suicide . In a survey conducted by the non-profit PCOS Challenge : The National Polycystic Ovary Syndrome Association, 62.15% of the 900 respondents reported high to severe mental health impacts caused by the condition.

I spoke to 10 people with PCOS, and all say they’ve felt unequipped to deal with the associated mental health impacts, partly because the syndrome itself is not fully understood. It can affect so much: self-esteem, gender identity, relationships and sexuality. Confusing medical advice, delayed diagnoses and a hodge-podge of imperfect treatments only exacerbate the emotional toll.

Not long after my explosive outburst, I sought help from a psychiatrist, hoping to understand and better manage my stormy moods. When I mentioned that these episodes always seemed to occur at the same time every month, I felt dismissed. The psychiatrist responded, “I see signs of bipolar disorder.” Though she refrained from an official diagnosis, she did offer a prescription for bipolar medication.

Some studies suggest a bidirectional relationship between bipolar disorder and PCOS. But bipolar didn’t fit my experience. “If mood symptoms appear monthly, this suggests a sensitivity to hormonal fluctuations during the menstrual cycle” and probably PCOS, says Phoutdavone Phimphasone-Brady, a clinical health psychologist in the Department of Psychiatry at the University of Colorado who specializes in PCOS.

While there’s significant overlap between symptoms – including mood swings, irritability and insomnia – I didn’t experience the excessive energy and out-of-character behaviors typically associated with bipolar disorder. Misdiagnosis could happen when providers aren’t familiar with PCOS, says Phimphasone-Brady, who recommends that patients see a reproductive psychiatrist or psychologist experienced in menstrual cycle-related mental health issues.

Experts say that people with PCOS may suffer from mental health issues due to a number of biological factors . Elevated levels of androgens, such as testosterone, can contribute to mood disturbances and anxiety. Insulin resistance, a common symptom, affects neurotransmitter function and mood regulation. Chronic inflammation associated with PCOS is linked to depression and anxiety . And emerging research suggests that people with PCOS have fewer beneficial bacteria in their microbiome, increasing inflammation in the brain and possibly worsening mood disorders.

After just one session with the psychiatrist, I felt like drugs were being pushed on me without a clear reason to take them – and the anxiety around my moods intensified. I knew the darkness would eventually return, but with my irregular periods, I struggled to get ahead of it. I wondered: should I meditate more? Just take the pills? Ramp up my self-care?

It’s easier to believe we can overcome health obstacles than to accept we’re powerless against the slew of macro forces that impede our wellbeing . Applying a hustle culture mentality to my PCOS symptoms felt more empowering than accepting the long-held and widely quantified truth that, medically, women’s bodies just don’t matter all that much.

How body image issues affect self-esteem for people with PCOS

The consequences of insulin resistance and elevated testosterone levels – such as weight gain and difficulty losing weight, excess facial and body hair, acne, and generally more masculinized appearances – can lead to low self-esteem and negative body image, a significant predictor for mental health issues , says Phimphasone-Brady.

Julieta Cardenas, a 33-year-old journalist from Queens, New York, gained 40lb after a PCOS diagnosis and starting medications for her physical and mental health. She has devoted ample therapy sessions to body image, but the combination of sudden weight gain, birth control and desensitizing antidepressants left her feeling “like a brain in a jar hooked up to a keyboard”. Cardenas says she doesn’t even perceive herself as “a sexual being” anymore.

Routine medical advice for people with PCOS often reinforces conventional beauty standards. Many healthcare providers encourage weight loss, as there’s some evidence that obesity may exacerbate the condition. However, dieting rarely leads to sustained results. With excess weight often part of PCOS, the effort can feel especially sisyphean. “When patients don’t reach a weight loss goal, they may feel as if they’ve failed,” says Phimphasone-Brady, especially when they’re following doctors’ instructions.

People living with PCOS also tend to experience weight bias in healthcare interactions. “Providers often hold the assumption that thin bodies are healthy and fat bodies are unhealthy,” writes Stacey L Williams in The Psychology of PCOS. When Normandie Luscher, a 35-year-old illustrator in Syracuse, went to the doctor for a persistent cough, she felt judged for her size. “The doctor was like, ‘So, tell me about what you’re eating,’” says Luscher, who’d already had bariatric surgery to treat the prediabetes she developed from having PCOS. “I was just like, ‘Why? What does that have to do with anything?’”

In lieu of evidence-based guidance on the best ways for PCOS patients to lose weight, there’s an abundance of diet advice on social media that’s both profit-driven and often grounded in misinformation . This could pose problems for a population that already has a higher risk of disordered eating .

How fertility challenges can affect mental health

PCOS is a leading cause of infertility in people of reproductive age; studies indicate that the infertility rate for those with the condition is about 15 times higher than for people without. At 38, Claire Salinda, a writer with PCOS in Los Angeles, constantly worries about her fertility. “I know my partner doesn’t love me based on whether I can keep his lineage going,” she says. “But because he wants kids, I feel pressure to deliver.” Salinda often feels less desirable because of her PCOS. “Who wants to have a baby with these ‘old’ eggs that aren’t even dropping regularly?”

Infertility can also be a significant blow to one’s sense of gender identity. When Anne Kamau, a 42-year-old salesperson from Nairobi, was diagnosed with PCOS, her gynecologist told her she might never have children. “I felt like he’d taken away something core to a woman’s life,” she says. Kamau did eventually have two children, and also started the PCOS Foundation of Kenya , which includes a WhatsApp support group of over 800 members going through similar experiences.

PCOS treatment and research have ‘long way to go’

PCOS is probably an ancient condition, writes Williams, but it wasn’t identified and labeled until 1935 – as Stein Leventhal syndrome , after the two doctors who discovered it. Almost a century later, there are still no FDA-approved drugs to directly treat this complex, multi-system syndrome that can cause lifelong ailments like type 2 diabetes, high blood pressure, uterine bleeding, heart disease and stroke. Among the 315 medical conditions that receive federal funding from the National Institutes of Health (NIH), PCOS ranks near the bottom .

“The main reason is the lack of recognition by physicians and researchers that PCOS is about more than infertility,” says Katherine Sherif, chief of women’s health at Thomas Jefferson University.

Currently, most PCOS research funding falls under the National Institute of Child Health and Human Development, which prioritizes reproductive health – only one piece of the PCOS puzzle. “It’s like an orphan; no one wants to own the research,” Sherif says, adding that it’s “reprehensible in this disorder that affects more women than diabetes and has profound effects on metabolic health”.

Limited funding for PCOS research has led to a lack of awareness and understanding among physicians. The NIH didn’t establish a working definition for PCOS until 1990, and up to 75% of people with PCOS remain undiagnosed after visiting their doctors. Sherif attributes delays to short gynecologist visits, which often miss complex conditions and the misconception that only overweight people can have PCOS. Non-gynecologists may also overlook a patient’s menstrual history, considering it irrelevant, she says. And despite their being disproportionately affected by the condition, Black women can experience further delays in diagnosis because of racial bias in medical settings .

“We have made progress, but frankly, there’s a long way to go,” says Sasha Ottey, the executive director of PCOS Challenge. “Women, and particularly PCOS patients, endure injustices of medical gaslighting, unnecessary surgeries, inaccurate and harmful medical advice and ineffective treatments that only compound the mental health burden of the condition itself.”

Treating PCOS costs an estimated $8bn annually in the US alone. This financial burden adds psychological pressure on patients already struggling with their mental health, especially in a fragmented healthcare system that creates barriers to continuous care and inflates out-of-pocket expenses. For instance, Cardenas’s $300 glucose sensors , essential for managing her insulin resistance, aren’t covered by insurance. “Being an advocate for your own care is exhausting,” she says.

Gaining recognition and finding relief for PCOS

This syndrome is getting more attention. PCOS Challenge successfully led an effort to have the condition recognized by US legislators in 2017, designating September as PCOS Awareness Month. Some drug companies are exploring new medications for the condition. And in 2023, leading researchers updated guidelines for PCOS assessment and treatment.

“There are effective therapies for mental health and research is surging to find more comprehensive treatments for PCOS,” says Phimphasone-Brady, who led a 2022 review that proved psychosocial interventions can significantly improve mental health issues related to PCOS.

Dissatisfied with my gynecologist’s efforts, I advocated for further testing. A thorough hormone panel showed I have very low progesterone, which can exacerbate symptoms like mood swings and insomnia, and a lack of bacterial diversity in my gut, which affects hormone regulation and increases inflammation. A high fiber diet and tailored supplements, on top of talk therapy and meditation, have helped my mental and physical health tremendously. Having firm data has also helped me recast my mental struggles in a more compassionate light; this is not my fault.

Instead of wondering what’s wrong with me, I now think about how to, as Phimphasone-Brady says, “make PCOS just a friendly passenger, rather than feeling like you’re on this rollercoaster ride and you don’t know where you’re going”. The prompt has helped me take better, more loving care of myself – and others I spoke to expressed similar sentiments. “I’m trying to treat my body like a dog,” Salinda, the LA writer, tells me. “That means giving it food, water, lots of pats and space to run.”

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Psychiatric Service Dogs for People With Mental Health Disorders

What They Do for Those with PTSD, Anxiety, Depression, Panic Disorders, and Other Conditions

• Who Benefits
• Getting a Psychiatric Service Dog
• Where You Can Take Them

Psychiatric service dogs (PSDs) are animals trained to support people with disabilities due to a mental health illness. These conditions can include post-traumatic stress disorder (PTSD), anxiety and panic disorders, depression , bipolar disorder, and schizophrenia, among others.

Psychiatric service dogs are different from emotional support dogs. PSDs perform specific tasks rather than providing overall comfort. Tasks may include providing tactile stimulation, distracting or redirecting your attention, bringing you medication, or getting you help when you need it.

This article explains what psychiatric service dogs do, who may need and qualify for a PSD, how these animals are trained, and the rights of owners and PSDs.

iStockPhoto / Getty Images

What Is a Psychiatric Service Dog?

Psychiatric service dogs (PSDs) are a type of service animal. They are trained to perform tasks for their human partners who have mental health disorders or disabilities. 

Traditionally, service dogs were those that helped humans with vision, hearing, and/or mobility impairments. Yet newer subsets of service dogs help with such conditions as psychiatric disorders, diabetes, and allergies. They can assist with mental health conditions that include PTSD , anxiety, depression, and bipolar disorder.  

What Are Service Animals?

Under the Americans with Disabilities Act (ADA), service animals are “dogs that are individually trained to do work or perform tasks for people with disabilities.”  This can include reminding a person with a mental health condition to take their medications, or calming a person with PTSD during an anxiety attack.

Breeds Used for Psychiatric Service Dogs

There is no specific dog breed required to be trained as a psychiatric service dog. They can be of any breed or size suitable for the tasks they are being trained to perform.

One study that surveyed Australian owners of PSDs found that the breeds varied widely and included both purebred and crossbred dogs. Ages ranged from younger than 1 year to 10 years, and the sex of the dogs was evenly distributed between males and females.

The most common reason owners chose their dog was based on temperament, followed by size and weight.

Tasks for a Psychiatric Service Dog

Tasks that psychiatric service dogs can perform vary based on the condition their human partner has. Examples include:

• Body contact to reduce anxiety 
• Tactile stimulation to induce calm
• Blocking people from their owner/handler
• Waking owner/handler experiencing nightmares or night terrors
• Nudging or pawing to bring back a state of awareness
• Reminding you to take medication
• Calming you during an anxiety attack, as with PTSD

A psychiatric service dog also can help with fetching water or medicine bottles, helping with balance and mobility, and reading signs of anxiety to alert others if you're in distress.

Who Can Benefit From a Psychiatric Service Dog?

While much research has been done on the benefits of service dogs in general, psychiatric service dogs have not been studied as much. They vary more in breed and size than traditional service dogs, and it is not possible to generalize regarding one type of service dog or another.

Some benefits to humans have been shown in studies of psychiatric service dogs. These include improvement in PTSD symptoms, reduced anxiety, and better sleep. Handlers with major depression and PTSD use less medication the more their dogs do tasks to help them.

Psychiatric service dogs can offer benefits to people diagnosed with:

• Anxiety Disorders : Studies have demonstrated benefits for people diagnosed with certain types of anxiety disorder, including generalized anxiety disorder (GAD) and panic attacks . They also may help with social anxiety disorder or a specific phobia like the isolating agoraphobia . Some people report dogs make it possible to leave the house, go grocery shopping, and go to school.
• Mood Disorders : These conditions include the mood swings of bipolar disorders as well as the sadness, fatigue, and other symptoms of depression , including those caused by seasonal affective disorder . Psychiatric service dogs can help people with these and other mental health conditions to feel "grounded" and connected in their present reality.
• Post-traumatic stress disorder : Some 62% of the people in an Australian study of PSD use were diagnosed with PTSD, which can follow exposure to a traumatic event. The dogs helped to reduce anxiety and other symptoms with body contact, deep pressure stimulation, and other interventions.
• Schizophrenia : A serious mental illness characterized by a loss of contact with reality, the schizophrenia diagnosis presents a number of challenges for daily living that PSDs can help.

Psychiatric service dogs also can help with:

• Obsessive-Compulsive Disorder (OCD) : OCD is a mental health condition in which people experience intrusive thoughts and repetitive behaviors. Psychiatric service dogs can interrupt cycles of unwanted behavior and help handlers to focus their thoughts.
• Autism Spectrum Disorder (ASD) : Autistic people experience neurodivergent traits that vary widely in how they affect communication, social interaction, and behavior. Animal therapy is common for autistic children and adults, with some studies showing a stress-relief benefit.
• Attention Deficit Hyperactivity Disorder (ADHD) : ADHD traits include hyperactivity, impulse behavior, and attention difficulties. Psychiatric service dogs can help with these traits.
• Dissociative Disorders : People diagnosed with a dissociative identity disorder ( DID ) or depersonalization-derealization disorder ( DDD ) can benefit from "grounding" and other interventions that psychiatric service dogs are trained to provide.

PSDs and Invisible Illnesses

Mental health conditions like PTSD, depression, and anxiety are invisible illnesses just like diabetes or hearing loss. A seemingly healthy person with a service dog might confuse people at first. However, that does not mean the person does not need the service dog in certain situations. It is important to be respectful and not approach or pet the dog without permission from the handler.

How to Get a Psychiatric Service Dog

The ADA defines someone with a disability as “a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such impairment, or a person who is perceived by others as having such impairment.”

As such, to qualify for a psychiatric service dog, the owner must have a mental disability that limits their life activities. This will vary in symptoms and severity from person to person, even among those with the same diagnosis. The need will have to be verified by a healthcare provider.

State and local laws are allowed to require that service dogs be licensed and vaccinated. They are also allowed to have voluntary service dog registration programs. However, they may not require service dogs to be certified or registered and cannot ban a service dog due to being a specific breed.

Locating a psychiatric service dog or trainer on the Internet is possible, but it's important to research providers or supportive training programs. Under the ADA, service dogs are not required to go through a professional training program or be certified through a specific entity. They also do not need to wear a vest or identification that shows they are a service dog.

Service Dogs vs. PSDs vs. ESAs

Psychiatric service dogs are a type of service dog, but they are different from emotional support animals (ESAs). ESAs are not “service animals” under the Department of Justice (DOJ) guidelines, as they do not perform work or specific tasks. Instead, ESAs provide general comfort, emotional support, and companionship.

Subset of service animals that have training in performing one or more tasks to help a person’s disability

Protected under ADA, Housing and Urban Development (HUD), and Department of Transportation (DOT)

Must be dogs

Examples of tasks: 

• Remind owner to take medication
• Check room for safety or turn on lights for those with PTSD
• Provide tactile stimulation through touch, nudge, lick, or pressure for someone with anxiety

Any animal, as long as it provides emotional support, alleviating one or more symptoms or effects due to a person’s disability

Protected under HUD, but not ADA or DOT

Any domesticated species that is manageable in public (Note that domestic U.S. airlines are not legally required to transport unusual animals, including reptiles, ferrets, rodents, and spiders. Foreign airlines are only required to transport ESA dogs.)

Rights and Laws for Psychiatric Service Dogs

Since PSDs are service dogs, they are protected under the ADA. This means they can go anywhere service dogs are allowed, including places that do not otherwise allow other animals or pets.

Under the ADA, service dogs can enter:

• Restaurants

Does My Psychiatric Service Dog Need Documents?

People working in a business or government facility are allowed to ask only two questions when determining if an animal is a service dog, including whether it is required for a disability and which specific tasks or work it is trained to do. You are not required to have documentation but when traveling by plane, some airlines may require you to complete forms about the dog.

The ADA also covers specific housing types, including public and private university housing, government-run public housing, and emergency shelters.

Regarding other housing and air travel, the DOT and the HUD both have regulations in place to protect service dogs and their human partners. However, if a dog is not housebroken or is out of control and unable to be brought back under control by its handler, businesses and state and local governments can ask for a service animal to be removed from the premises.

Service dogs, including psychiatric service dogs, are not required to be professionally trained, so anybody with a disability has the right to train their service animal themselves. However, since service dogs in training are not covered under the ADA, they may not be allowed in certain public places unless covered by state and local laws.

Recent Changes for Air Travel

In late 2020, the DOT Air Carrier Access Act was modified to no longer consider emotional support animals as service animals. However, they also now require psychiatric service dogs to be viewed and treated the same as other service animals. More information can be found on the U.S. DOT page on service animals .

Mental health illnesses can cause disability and the inability to perform some daily tasks, just like physical illnesses. For some people, a psychiatric service dog may provide additional support for their daily life outside of other treatments and medications.

If you are wondering how a PSD may help you, speak with your healthcare provider or mental health professional. They can provide you with resources and discuss options with you.

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By Alison Yarp, MD, MPH Dr. Yarp is a public health physician with interests in mental health, violence prevention, and emergency preparedness.