A panel of influential national health experts is recommending anxiety screenings for all U.S. adults, and a Colorado behavioral health expert calls the greater focus on anxiety a wise move.

Dr. Justin Ross has witnessed a dramatic rise in people who are coping with anxiety and endorses universal anxiety screening.

“Anxiety is one of the most common and pervasive human experiences,” Ross said.

To get help with anxiety — if it’s proving problematic for you — it’s key to first recognize it, and that’s where universal anxiety screening could help.

“Anxiety can serve as a reminder that something we care about either is, or is perceived to be under threat. For many people, anxiety is a daily occurrence that ebbs and flows with our various life circumstances,” Ross said.

“For many others, anxiety is a pervasive mental health condition that significantly impacts the mind, body and spirit. Collectively, we need to do a better job of understanding the impacts of anxiety, not only for ourselves but for our community, and work to provide appropriate resources to help those in need,” said Ross, a licensed clinical psychologist and UCHealth’s director of workplace well-being.

The U.S. Preventive Services Task Force is an independent body of national U.S. health experts who make recommendations about the value of various health screenings. Their recommendations carry a great deal of weight and typically become standard practice in doctors’ offices.

Earlier this fall, the task force made draft recommendations encouraging primary care providers to screen all adults, ages 19 to 65, for anxiety. The advice for adults follows recent final recommendations that all children and teens, ages 8 to 18, also be screened for anxiety.

To understand more about what anxiety is, how it can be treated and how everyone can reduce stress, we consulted with Ross, who is also a clinical professor of medicine and internal medicine at the University of Colorado School of Medicine on the Anschutz Medical Campus.

What is anxiety?

People with anxiety disorders experience persistent worries and intense fears even when they’re in non-threatening situations.

There are multiple types of anxiety disorders. They include generalized anxiety disorders, panic disorders, social anxiety and phobia-related disorders.

Do I have anxiety?

Ross said the simplest way to know if you have anxiety sounds silly but is pretty straightforward.

“The starting point is, ‘do you feel anxious?’ And if the answer is ‘yes,’ you start there to better understand what that means more specifically for that individual.”

It’s also common for people to do what’s known as ruminating or perseverating. Many people with anxiety will keep repeating an action or continuously thinking about something that is bothering them.

“People experiencing anxiety may spend a lot of time and energy running over the same scenario in their minds,” Ross said.

If you have anxiety, you may feel symptoms associated with your mind like nervousness, distraction or repetitive thoughts. Are physical symptoms common with anxiety too?

Yes, absolutely. There’s an emotional experience of feeling anxious or nervous. Physical symptoms of anxiety disorder also are very common, Ross said.

“The physical response could be a sense of agitation, an increased heart rate or a higher body temperature. It can also manifest with gastrointestinal distress, stomachaches, or headaches.”

How do I know if my anxiety is normal or if I need help from a medical provider or mental health professional?

This is where the value of screenings and increased knowledge about the prevalence of anxiety comes in.

“One of my favorite sayings is, ‘you can’t change what you’re not aware of,’” Ross said.

First, we all need to be aware that anxiety is a common human experience.

“From there, you’ll want to understand how anxiety may manifest for you. It’s about understanding what it looks like for each person so they can learn to manage the symptoms.”

Ross said it’s wise to get help with anxiety if it’s interfering with daily living. If you’re dealing with distractions or intrusive thoughts at school or work or having trouble getting to sleep or staying asleep, then it’s time to ask your primary care provider or a therapist for help.

What are the treatments for anxiety?

Psychotherapy — especially a method called cognitive behavioral therapy — can be very effective in helping people cope with anxiety. Meditation also proves helpful.

Various medications can also reduce anxiety. Options range from antidepressants to antihistamines, beta-blockers, anticonvulsant medications and benzodiazepines, according to task force experts.

Some people who have anxiety also have depression. That’s another reason that routine screenings could be so helpful. Experts can help detect anxiety and assist with treatment.

Which questionnaires would primary care providers use to screen people for anxiety?

The most common screening tools in the U.S. include various questionnaires that patients fill out. They include the Generalized Anxiety Disorder scale, the Edinburgh Postnatal Depression Scale, the Geriatric Anxiety Scale and the Geriatric Anxiety Inventory.

If answers to a questionnaire result in flags, then a provider needs to follow up to determine if a patient is indeed suffering from anxiety.

What if people aren’t comfortable talking about anxiety? Is that common?

Yes. Ross said it’s very common for people who are coping with anxiety and other mental or behavioral health challenges not to feel comfortable talking about their experiences.

The idea of a standard screening is to encourage doctors and patients to increase awareness about anxiety and to openly discuss it.

If screenings for anxiety become standard in doctors’ offices, Ross said it’s vital for patients to answer the screening questions honestly.

How important is it for patients who are struggling with anxiety to tell the truth when they respond to screening questions about anxiety? 

Primary care providers and behavioral health experts like counselors and therapists can’t help people with anxiety if patients don’t share their symptoms and honest responses with their medical team.

Responses to anxiety screening questions could be similar to those related to substance use. Doctors routinely ask patients how much alcohol they’re consuming or whether they’re using drugs. If patients don’t answer these screening questions honestly, doctors can’t help them.

“The potential biggest concern with this approach is that some people may find that the screening is another formality, another checklist that they need to complete but will not perceive it as the first step in getting help,” Ross said. “If there’s no trust in this being the first step in treatment, there may be a tendency to just check ‘no’ to boxes.”

Medical providers know that patients aren’t always frank with them. That can be due to shame or a sense of hopelessness.

“In screenings, we may not be honest if we don’t think we’re going to get the help or support we need,” Ross said. “People need to know that when they’re honest, there will be the right support, treatment and resources available to them.”

What is one of the best models you’ve seen to give patients good support for anxiety and other mental or behavioral health challenges?

One of the best models is one in which patients can easily see both their primary care providers and a behavioral health provider in the same location in primary care clinics, Ross said.

UCHealth has been expanding seamless, easy access to behavioral health experts throughout primary care clinics in Colorado. If patients come in for a medical checkup and share concerns about behavioral health challenges like anxiety, substance use or depression, for example, they can easily follow up with a behavioral health expert who works in the same primary care clinic. Visits with the behavioral health expert typically are covered through health insurance. (Read more about how integrated care for both physical and mental or behavioral health works.)

Providing easy, affordable access to counselors and therapists in a primary care setting reduces stigma about mental health challenges and makes it easier for people to get the treatment they need, Ross said.

Thus far, UCHealth provides integrated behavioral health providers in 44 clinics and, due to high demand from patients, the program continues to expand quickly.

I hear there’s a shortage of behavioral health experts and therapists who can treat anxiety and other mental health challenges. Is that true?

Yes. That’s true. Across the U.S., many people are struggling to find or afford visits with a therapist or counselor. That’s why the integrated model that combines access to primary care and therapy is so promising.

If you are in crisis or a family member needs help urgently, try the 988 Suicide & Crisis Lifeline: Call or text 988.

Other resources for finding a therapist:

• Ask you primary care provider.
• Call your health insurance company (or check online) to get a list or providers.
• Seek confidential support through an Employee Assistance Program. If your employer offers this benefit, you and family members might receive invaluable access to therapists and counselors.
• Check the Open Path Collective, a national nonprofit network that aims to offer affordable access to therapists. (Always be sure that the provider is properly licensed and has good reviews from patients.)

How common is anxiety?

Anxiety is very common. In their draft recommendations, the U.S. Preventive Services Task Force cited data from the early 2000s showing that during a person’s lifetime more than 40% of women and 26% of men were likely to deal with anxiety. It’s especially common during pregnancy and after women give birth.

And the pandemic triggered a dramatic increase in reports of anxiety. According to one study that the task force cited, the percentage of U.S. adults who reported that they were dealing with anxiety or depression jumped from 36.4% to 41.5% from early 2020 to 2021.

Ross said he’s not surprised that the pandemic triggered such high rates of anxiety because it brought so much disruption and uncertainty.

“In my opinion, there are three major building blocks for anxiety. The first is a layer of unpredictability. When we look into the future, we’re not sure how things are going to play out.

“The second is a sense of not having control,” Ross said. “And the third is when something or someone we care about is threatened (or we perceive that there’s a threat).”

Once pandemic worries ease, will anxiety also decline?

Ross said that the percentage of people coping with anxiety may decline when they have greater predictability and a greater sense of control over their well-being or circumstances.

But once people start suffering from anxiety, it can continue to bother them.

“Cracks open and can stay open for a lot of people. Anxiety can then keep them in a heightened state,” he said.

Can both children and adults get anxiety?

Yes. It’s common for anxiety to begin in childhood. The median age of onset for kids is 11. Experts say the prevalence continues to increase throughout adulthood.

While more studies are needed, researchers believe that anxiety rates are the lowest among adults ages 65 to 79.

Is it common for people who have anxiety not to know they have it?

Yes. Experts at the U.S. Preventive Task Force say “under detection” appears to be common.

Few people with anxiety share their concerns with their doctors, and only 11% of people with anxiety are getting help for it within the first year after diagnosis.

The median age for people to get help with anxiety is age 23.

Screening for anxiety in both children and adults may help with earlier diagnosis and treatment. Many people who have anxiety visit their doctors and report other problems like pain or trouble sleeping.

What can people do on their own to decrease anxiety?

“There are a lot of things we can do to help manage anxiety,” Ross said. “These include relatively simple daily behaviors like deep breathing, exercising and getting fresh air.”

Tell me more about breathing. Do you have to do formal meditation or do simple breathing exercises help?

Deep breathing can be a great place to start. Ross recommends slowing down and scheduling quick, deliberate deep breathing sessions lasting at least three times a day. These micro-breaks need not be long. Each session can be as brief as one minute.

“Breathing exercises are the simplest way to reduce stress and anxiety in the short term,” Ross said. “Slow your breathing to tell your body that there’s no immediate threat. We’re built to kick into gear quickly if we need our ‘fight or flight’ response. But stress also can trigger the same systems. And our bodies don’t do well if we’re constantly on high alert. Breathing communicates this in our nervous system and gets us back to a place of balance.”

Ross said breathing is incredibly valuable because it helps us manage the anxiety response on a physical, physiological and mental level.

The physical level is how the body reacts. The physiological response centers on the nervous system. And of course, our mental responses relate to how our brain is responding to stress, Ross said.

Breathing deeply has the remarkable power to affect people on all three levels.

“One minute of deep breathing helps slow down the sympathetic nervous system — the fight or flight response associated with anxiety. Breathing also helps turn on the parasympathetic nervous system, which helps us restore balance and can provide a sense of calm and focus,” Ross said.

Aside from deep breathing, what are some other self-care methods for reducing anxiety?

Ross recommends deliberately carving out breaks. And physical activity is enormously helpful.

“Take a walk. Take a bath. Read a book. Do things that are deliberately calming. Sitting on the couch and binging Netflix can seem relaxing, but it also can be avoidance behavior that isn’t actually restorative at all,” Ross said.

In order to take care of ourselves in restorative ways, we need to make deliberate decisions.

You also recommend ‘active self-care.’ What is that?

“Physical activity, exercise and anything that connects you to meaning and purpose all has the potential to work,” Ross said.

Finding balance and being deliberate about your choices are vital. If you’re constantly going on runs, but aren’t taking time to check in on your mental health or to rest and recharge, then you might not feel better, even after a long run.

Ross, himself, loves to run and cycle.

He recently set a major goal for himself. He trained for and completed the extremely challenging Leadville 100 mountain bike race over the summer.

“There’s a lot of evidence to show that exercise is a really helpful treatment for both anxiety and depression,” Ross said.

Physical activity clearly has benefits for our physical health, but also for our mental health. Exercise also serves as a proactive outlet to deal with stress.

“Plus, we give ourselves something to look forward to. That’s really important for our mental health. For me, training and competing in endurance events is not only important for me personally, but the daily training provides me an outlet and helps me manage my own stress and anxiety. Yes, even trained psychologists experience stress and anxiety, and we have to utilize the same strategies that we recommend to our patients and to the public.”

While setting goals is helpful, you don’t need to run a marathon, climb a 14-er or accomplish a huge feat.

Setting exercise goals and making plans with friends are great. Make plans to walk, run, hike, cycle or play a sport like pickleball with a friend.

If the weather is lousy, call a friend and challenge each other to work out indoors.

“People say, ‘I don’t have time,’” Ross said. “But if you make movement a priority, you will find a way to make it happen. Prioritizing time to exercise and meditate by putting it in your schedule and protecting that time is going to make a huge difference in your mental health.”

You also emphasize the value of connecting with people. Why are social interactions so critical to fostering better physical and mental health?

The forced isolation and physical distancing during the worst periods of the pandemic proved how much human beings need to connect with one another, Ross said.

Children performed poorly in schools when they had to attend online classes. Many adults of all ages experienced severe loneliness and for some, addiction issues worsened.

Ross thinks anxiety reports skyrocketed over the last two years because people need to connect with one another and they need milestones — from vacations to work gatherings to birthday parties — to look forward to.

“All of these things are near and dear to our psychological well-being,” Ross said.

Implementing new, universal primary care screenings for anxiety could be challenging, but invaluable.

“It’s a huge lift. But anxiety is a very common human experience,” Ross said. “We need to capture how pervasive it is and help create pathways for resources, treatment, and support.”