Marieke Gilmartin, a third-year postdoc in neuroscience at the University of Wisconsin, Milwaukee, has always been a bit anxious and shy. Her default coping strategy: avoid situations that make her feel uncomfortable. But as she embarked on a science career, she encountered stressful requirements and expectations that she could no longer avoid.

As a graduate student, Gilmartin got anxious before meetings with her supervisors. Talks in front of her department were unbearable. "I would be nauseated for days leading up to a talk, lying down, unable to practice or to think, which of course made the anxiety worse," she says.

A graduate adviser who was trying to help unwittingly exacerbated her fears. "He would spend hours with me in the practice room, saying things like, 'You can't say it that way,' or 'Dr. So-and-So will tear you apart on that issue,' or 'You better have an answer for that.' " People around her told her it was normal to be nervous. Don't we all get butterflies in our stomachs before a talk?

Attending social meetings during the Society for Neuroscience (SFN) conference, Gilmartin experienced similar anxiety when attempting to network with other scientists. She watched other young professionals chatting, relaxing, and having drinks. In contrast, she felt jittery, self-conscious, red-faced, and sweaty. "Everyone seemed to know each other, and I felt like an outsider, not sure how to start a conversation," she says. Once she was in a conversation, she was hyperfocused on how she was presenting herself. Despite these feelings, she almost always attended, but she never had a good time. The socials gave her a "just get me out of here so I can relax feeling," she says.

Gilmartin's first really bad experience occurred while she was making a presentation to her class. "I lost vision in my eyes. I was able to answer questions from the audience, but I couldn't see anyone," she says. She later learned that her momentary blindness was caused by something called a vasovagal response, presumably triggered by not eating anything that morning. She hadn't eaten because she was too nervous.

Nearly a year into her postdoc, Gilmartin was asked to give a talk to her new department. She realized she was still terrified. "I fumbled through practice talks, panicking that I wouldn't even pull it together." In the end she managed, doing a good job and exuding confidence. Only a few close colleagues knew how anxious she was. A couple of weeks later, her supervisor asked her to speak to the Pavlovian Society. Having just gotten past one suffocating challenge, she faced another. "That was the last straw," she says, "I finally had decent medical insurance, so it was time to get help."


NSF/ Paul Thompson and Arthur Toga, UCLA

When anxiety crosses the line

Some anxiety in the face of stress can be a good thing. It helps us work harder, prepare more thoroughly, and perform with more intensity. But people of different temperaments become anxious to varying degrees. Some are laid-back and carefree; others seem to have been born to worry to excess. Experts believe, in fact, that people may be hard-wired in the way they experience anxiety.

Brain imaging and neurochemical studies suggest that the amygdala and hippocampus play significant roles in the etiology of anxiety disorders. Researchers at Weill Cornell Medical College recently identified a gene abnormality that is associated with anxiety-related behaviors; it makes humans and mice hypervigilant to cues that signal danger. Although scientists still don't precisely understand the interactions among genetic, environmental, psychological, and developmental factors, research suggests that high anxiety tends to run in families.

According to the National Institute of Mental Health, anxiety disorders are among the most common and treatable mental disorders. More than 40 million adults -- almost one in five -- experience anxiety so intensely that it interferes with their ability to function. That makes it a diagnosable disorder -- rather a group of disorders that includes panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias (social phobia, agoraphobia, and so on). Epidemiological research has shown that anxiety disorders often co-occur with depression and substance abuse.

A table (reprinted below with permission) from the Anxiety Disorders Association of America (ADAA) provides useful guidelines for differentiating between "everyday anxiety" and an "anxiety disorder."

Everyday anxiety or an anxiety disorder? (ADAA)


Everyday Anxiety Anxiety Disorder
Worry about paying bills, landing a job, a romantic breakup, or other important life events Constant and unsubstantiated worry that causes significant distress and interferes with daily life
Embarrassment or self-consciousness in an uncomfortable or awkward social situation Avoiding social situations for fear of being judged, embarrassed, or humiliated
A case of nerves or sweating before a big test, business presentation, stage performance, or other significant event Seemingly out-of-the-blue panic attacks and the preoccupation with the fear of having another one
Realistic fear of a dangerous object, place, or situation Irrational fear or avoidance of an object, place, or situation that poses little or no threat of danger
Making sure that you are healthy and living in a safe hazard-free environment Performing uncontrollable repetitive actions such as excessive cleaning or checking, or touching and arranging
Anxiety, sadness, or difficulty sleeping immediately after a traumatic event Recurring nightmares, flashbacks, or emotional numbing related to a traumatic event that occurred several months or years before

Anxiety disorder or workplace anxiety?

A 2007 study by researchers Michael Linden of Charité University of Medicine and Beate Muschalla of Rehabilitation Center Seehof, both in Berlin, was the first to examine the link between anxiety disorders and workplace-related anxieties.

The researchers interviewed 132 patients at a psychosomatic rehabilitation center. Of those diagnosed with anxiety disorders, 71% of women and 54% of men complained of work-related anxiety. Fourteen percent of the study participants reported that their anxiety was limited to the workplace.

Although there is some overlap, the researchers emphasize that anxiety disorders and workplace anxiety are not the same. Anxiety disorders often appear in the workplace, but workplace anxiety can be a problem on its own. In an article published in the Journal of Anxiety Disorders, the researchers write, "Work-related anxieties can manifest in the form of phobia, social anxiety, generalized anxiety, fears of insufficiency, or hypochondrial anxiety in relation to work, working conditions, or colleagues and superiors."

The perfect storm

In another study of work stress, University of Otago researchers interviewed 900 New Zealanders in their early 30s. They found that high-pressure jobs are associated with an increased risk for anxiety and depression.

For someone temperamentally prone to high anxiety, an academic laboratory can be loaded with triggers. By dint of his position in the hierarchy, a trainee tends to feel powerless and as though he lacks control. Compounding that, the scientific enterprise is rife with high expectations and intense competition for promotions, tenure, space, and funding. Trainees and beginning scientists are likely to be chronically stressed by grant and publication deadlines, long working hours, sleep deprivation, and constant struggles to achieve work-life balance. In an article called "Grad-School Blues" in The Chronicle Review, reporter Piper Fogg wrote: "Graduate school is gaining a reputation as an incubator for anxiety and depression."

Depending on an individual's temperament, role, and workplace stressors, symptoms of anxiety take different forms: procrastination, avoidance, fatigue, irritability, fearfulness, social isolation, obsessiveness, perfectionism, or a feeling of constantly being overwhelmed -- all of which result in diminished efficiency. In dire cases, unchecked anxiety disorders can derail careers and even result in suicide.

For the lab group or organization, anxiety can lead to excessive absenteeism and reduced productivity, so it is prudent for supervisors to be alert to the signs and to respond appropriately to requests for help. Of course, supervisors and advisers can help alleviate anxiety in the way they manage their laboratories and workplaces. One of the most important ways of minimizing anxiety is by providing guidance and support and setting short-term goals that are achievable.

Getting help

"My realization that I had a problem with anxiety was delayed by me being a scientist," says postdoc Gilmartin. "It's normal to put your nose to the grindstone in the lab, and you don't necessarily have to deal with people. In a corporate position, it probably would have come up quicker," she says.

Often, well-meaning friends or colleagues expect people with anxiety disorders to just snap out of it. Unfortunately, the anxious colleague often knows that she is worrying to excess but is unable to change on her own.

While in graduate school, Gilmartin saw a psychiatrist employed by the university and participated in a research study on anxiety. With better insurance and more options as a postdoc, she sought help from a psychologist trained in cognitive behavioral therapy (CBT). In contrast to psychoanalytic therapies that delve into someone's past, CBT helps a person focus on current problems through an active partnership between the patient and the therapist. The point is to identify unhelpful thinking patterns, recognize and change inaccurate beliefs, and learn to relate to others in more positive ways.

"The therapist told me that there is absolutely no reason anyone should walk away from science due to anxiety, as it is treatable. I realized my anxiety was not just for giving talks but was somewhat social as well," she says. "Some of the homework was very hard and somewhat embarrassing, but that's the point of exposure therapy," one type of CB,: "to put yourself in awkward situations and realize that the end of the world doesn't happen."

Although CBT was useful to Gilmartin, others benefit frommedication , other specific forms of psychotherapy, and combined treatments. A positive response to treatment can take months to more than a year. But despite the effectiveness of treatment, stigma and misunderstanding lead many people to avoid seeking help for anxiety problems. Surely cost -- and inadequate insurance coverage -- is also a factor for science trainees. According to ADAA, only one-third of individuals with anxiety disorders receive treatment. Participation in support groups and forums can help people identify treatment resources and recognize that they aren't alone.

Gilmartin also joined Toastmasters International to polish her public-speaking skills. And today her anxiety is much more manageable. She's more outgoing socially. This year, she's looking forward to her talk at SFN. "I may even reach the point where my pre-talk nerves only manifest minutes before the talk and are the good kind of performance-enhancing nerves," she says.

Irene S. Levine is a freelance journalist whose work has appeared in many of America's leading newspapers and magazines. Trained as a psychologist, she works part time as a research scientist at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York, and she holds a faculty appointment as a professor of psychiatry at the New York University School of Medicine. She resides in Chappaqua, New York.
10.1126/science.caredit.a1000087