Anxiety: Breaking the Mental Health Taboo in Silicon Valley
As a physician in a practice serving over 3,000 Bay Area patients, the vast majority of whom are startup founders and tech workers, I have a unique vantage point into the physical and mental health of Silicon Valley. It may be surprising to some to hear that more than 20% of our patients present with some form of behavioral health issue, most often anxiety.
Anxiety is a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. But sometimes anxiety presents without any identified trigger. The problem starts when emotional engagement turns sour. Thinking becomes overthinking, planning becomes worrying, and self-awareness becomes fear of public speaking or performance.
People suffering from anxiety are often highly functioning with recognized successes and no history of needing medical or psychological assistance. A high performance mentality carries the risk of hypervigilance, which can ultimately be counterproductive and hinder performance.
The rapid pace at which companies form, grow, exit, and die creates more than enough uncertainty for anxiety to take root.
This problem is by no means unique to Silicon Valley. It is common with the high IQ, high performance professionals I also saw while working for the U.S. military. I would not be surprised to see similar patterns in, for example, politicians in DC or investment bankers in Manhattan.
“There is not enough Ambien in the world to treat insomnia when the underlying cause is anxiety.”
Anxiety hides
Diagnosing anxiety is challenging because it can be masked as a variety of symptoms, such as:
- Insomnia
- Generalized aches and pains, especially back pain and abdominal symptoms
- Attention Deficit
- Restlessness
- Irritability
Uncovering the cause of these symptoms is crucial. Frankly, there is not enough Ambien in the world to treat insomnia when the underlying cause is anxiety. Often what presents as a sleep problem is actually daytime anxiety that goes unaddressed. Treating the symptom without addressing the cause only makes things worse.
Stigma
It’s easy to feel uncomfortable about speaking to a professional like your doctor about anxiety. It shows that you have insight into your life situation, but also vulnerability. Reaching out is always an act of courage. My patients are often unaware that their symptoms are common, that it is ok to talk about them, and that treatments are available. When I tell them that their symptoms are not unique, most find comfort in the fact they are not alone. It is refreshing for them to learn that intruding feelings of pre-meeting jitters and sleepless nights are common and treatable.
A survey we commissioned found that 30.7% of U.S. respondents have had an episode of anxiety lasting a month or more during the past year.
Diagnosis and Treatment
How does one know if your symptoms are rooted in undiagnosed anxiety? Your primary care provider will listen to your history and order basic lab tests if necessary. These are essential first steps in excluding other medical causes.
Cognitive Behavioral Therapy (CBT) is the most widely used evidence-based practice for treating anxiety. Its goal is to change patterns of thinking and behavior that trigger people’s difficulties. Cognitive behavior therapy is often at least as effective as medication with more durable effects. CBT combined with medication yields even better results.
Additional lifestyle approaches are less rigorously studied, but exercise and practicing yoga are often just as effective as medications or cognitive behavioral therapy. Mindfulness and meditation have varied results, with conflicting supportive data. Anecdotally, I do find very these helpful for my patients while improving other aspects of health.
What the future holds
Using technology to treat anxiety is in its infancy. Virtual reality, biofeedback and brain stimulation are used by isolated clinics and providers. A new set of apps are available which focus on aspects of cognitive behavioral therapy and mindfulness. Meanwhile, some apps are used to better connect patients with traditional therapists, enabled by technology, to expedite communication and track improvements.
Individuals suffering from anxiety can lead healthy and productive lives, but in order to get there, we need to remove the stigma and make it safe for everyone to talk about mental health. Remember that these issues are common. You are not alone.
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