(7 of 7)
The cognitive part of the CBT protocol can be a powerful tool too, teaching people to face their fears with a sort of existential shrug. "One of the problems of chronic worriers is that they tend to have predictions of catastrophic outcomes that crowd out their consciousness," says UNC's Wilson. A better approach is to accept that your performance or presentation might crash and burn and decide that even when such disasters occur, they're not fatal. It's how Jenny Allen, an actress currently appearing off-Broadway who used to be gripped by anxiety before every performance, learned to cope with her demons. "I was always thinking, I'm gonna forget my lines. Is the line 'Where's the hat?' or 'What have you done with the hat?' I would get onstage clammy, sweating and feeling uptight, with shallow breathing." Now she takes deep breaths and stays focused on the story she is telling.
Extreme anxiety can be managed in acute moments by drugs like Xanax, Valium and other benzodiazepines, which broadly suppress the activity of brain chemicals, but they can be addictive and do nothing to help sufferers acquire meaningful coping skills. Some antidepressants also have antianxiety properties and can often make people not helped by CBT more receptive to it. Eventually, better understanding of the neural pathways of anxiety will help pharmacologists develop more precisely targeted drugs. And a more thorough mapping of the brain's genes--along with better epidemiological understanding of the heritability of anxiety conditions--can identify likely anxiety sufferers early on and help them learn coping skills that can make anxiety treatment preventive rather than therapeutic.
Until then, we could do worse than to follow the example of the very savvy, if very unscientific, Lewis. "I spend about 30 to 40 hours looking over thousands and thousands of ideas on my computer before a show, and I tell myself to let it go, have some confidence," he says. "The anxiety will creep in there really fast, but I eventually embrace it and say enough is enough."