-When our communities need help, Blue Cross and Blue Shield companies step up with partnerships capable of preparing meals for thousands of families in need, because it's not just about health insurance.

We believe it's our responsibility to expand care to rural communities, protect our heroes with safety equipment, support local nonprofits.

These are our stories to help build stronger communities for the health of America.

-"Second Opinion with Joan Lunden" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.

-Anxiety is the most common mental health disorder in the United States, affecting nearly one third of both adolescents and adults.

And according to new research, millennials have become the most anxious generation in history.

We will discuss why on today's program.

Joining us today is our primary care physician, Dr. Lou Papa from the University of Rochester Medical Center... -Growing up in the age where I was before all this technology, there was ways to get away, right?

I don't know if your generation really gets to do that.

-...and Dr. Khadijah Watkins, associate director of the Child and Adolescent Psychiatry Residency Training Program at Massachusetts General Hospital and McLean Hospital.

-It has to be part of a comprehensive evaluation, and it has to be part of a greater treatment plan, because pills aren't skills, so you still will need the therapies and the skills and strategies to manage anxiety.

-And also, Julie Campanella, who, like so many other Americans, has been dealing with anxiety.

-Therapy is awesome, and it's nothing to be afraid of.

And find a good one, and don't be afraid to leave one if you don't like them.

-And I'm Joan Lunden, and it's all coming up here on "Second Opinion."

♪♪ Anxiety -- it is a word that we hear thrown around all the time, but for some people, anxiety can be absolutely debilitating.

And we thank all of our panelists for being here today, but I want to come right straight to you, Julie, because you've really dealt with this in a big way.

But as a child, what was your childhood like?

Were you an anxious child?

-I was a hyper child.

[ Laughs ] I was a happy child.

I was active.

I had a great childhood.

I have a lovely family.

But I really didn't seem to have anxious issues until I was more in the teenage years.

-So, as a teenager, though, I think you were 17, and you were in -- what?

-- a chemistry test... -Yes.

-...which, believe me, can be anxiety-producing for a lot of us.

-Yeah, definitely.

-But what you experienced was way over the line.

What happened?

-So I went into my test, had a normal day at school, and I go into my chemistry room, and we sit down and take the test.

The paper's on my desk, and I look down at it, and I honestly don't remember what I was thinking about before.

I don't know what was going on that day.

I couldn't tell you.

But I looked down at the paper, and just, like, overwhelming dread came over me.

First time I ever experienced that.

The words on the paper kind of mixed around, the formulas.

I didn't know what I was looking at.

And I just -- the walls started closing in, and I got up and I walked right out of the room, and I didn't tell my teacher where I was going.

I just left, and I was sobbing immediately in the hallway, sobbed to the nurse's office, chest was tight, started hyperventilating and crying.

I went to the nurse, told her I was leaving.

She didn't get a chance to ask me why.

I walked away, went to my locker, got my car keys, and called my mom in the car, totally freaking out, crying.

She had never heard me like that before.

We're a pretty strong emotional family, like, pretty stoic people.

-So you have a support system, but -- -Totally.

Family's lovely.

-Wow.

-They're there for me all the time.

But she -- she had never heard me be so upset.

And I tried to drive home, had to pull over 'cause I was still hyperventilating.

I don't remember much, but I remember I cried for probably more than two hours.

My parents weren't home when I got home.

I remember crying in front of the mirror and looking at myself, like... -Like, "What's wrong with me?"

-..."Why are you even crying right now?

Like, you're not sad."

Like, it wouldn't stop.

My mom came home and, you know, having someone else there to talk to me helped.

I calmed down eventually, but it was the first time I ever was out of control of my emotions.

And there was also physical pain there.

Chest hurt, you know.

-And you went to the doctor?

-Not that time.

Not yet.

-Oh, so then it kept happening.

If Julie walked in -- as a primary care physician, if she walked in and started telling you, really describing these symptoms, what would you think?

What would you want to ask her?

-So, she gave a really key word there, which is that sense of dread.

That's a real red flag to me in terms of a panic attack.

-Yes.

-However, you want to make sure it's not related to other things, you know.

Even though she's young and healthy, you know, there's congenital heart disease that can occur.

There's thyroid issues that can occur.

-Oh, yeah.

-There's neurologic issues.

There's drug and alcohol issues that all we would try to tease out with that.

If this happened the one time, we'd want to see if it continued to happen.

One of the key things I'd want to know is, was there something that you were panicked about?

Was this test something you were anxious about?

Was it something you were worried about?

Or this just came out of the bolt blue?

-So, what you were hearing was she was probably having a panic attack, what we know, I guess, as a panic attack?

-Right.

So, the panic attack is -- it was really beautifully described by you.

I'm sorry.

-That's okay.

-Which is that sense of dread.

You feel like you're gonna die.

Just overwhelming sense of, you know, fear or doom.

-A heart attack.

-And then there's all these symptoms along with it.

-Yeah, you kind of experienced like that.

Dr. Watkins, what is physically happening in our body when we're having a panic attack?

-So, when you're having a panic attack, your body is telling you there's danger and you need to flee, so that's why you have all of those revved-up symptoms, so probably experiencing your heart beating really fast.

You might be breathing fast or hyperventilating.

You might feel that your heart is actually pounding.

You might start to sweat.

So these are all part of the kind of fight-or-flight response that our body engages in when it tells us we're in danger.

And panic attacks can be cued with a trigger, or they can come out of nowhere, which makes them feel incredibly challenging.

-And frightening, I'm sure.

-Right.

-And these continued, I know.

-They do.

-So, but in your 20s, I mean, you had a couple of traumatic events.

You lost a couple of friends, and then you had one big traumatic event.

-Yes.

-Tell us about that.

-Well, I had a sexual assault, before the #MeToo movement, so it was hard to talk about it, you know?

Like, you feel ashamed for not doing more to stop it.

It was with someone I knew very well.

It was with somebody I dated for years.

Broke up with him.

He was very angry, wanted to come talk about it, and then forced himself on me, and with my roommates home, and, like, you know, nothing was done about it, and they didn't know what was going on, and... didn't tell anyone about it for a long time, 'cause it's -- you don't want to talk about it.

You want to forget it happened.

-Yes.

-You don't want to think it was real, 'cause -- -Yeah, no closure, really, to it.

-No.

I've always considered myself a brave person.

I'm outgoing.

I'm -- I'm there for -- you know, I'm the strong one of my friends, typically.

And so to admit to somebody that this happened, or I let this happen to me -- that's what I felt.

-That's how you'd experienced it.

-Right.

-Well, Dr. Watkins, what are the mental health issues or disorders that can come out of a really traumatic event like that?

-So, this shouldn't have happened to you, and I'm so sorry that it did.

And I appreciate you being willing to even talk about it.

When someone experiences a trauma like this, there are lots of things that can happen.

You can develop something called PTSD, where it's a constellation of symptoms, where you have flashbacks.

You might have nightmares of the event.

You might also, during the day, have intrusive thoughts about the event that you can't get out of your head.

Again, your body kind of goes into this revved-up mode and you feel on edge.

You know, you startle really easily.

You have trouble actually falling asleep.

Your body is just really kind of on hyperdrive.

So that's one of the things that can happen.

But you could also just have depression and general anxiety because you're worried about your safety, and you're in a constant state of fear.

-Yeah.

-So it can have a lot of rippling effects.

-And I see Julie's been here shaking her head during all of that, so you were experiencing that.

-Yes.

-I imagine it even can affect future relationships and trust issues and -- -Oh, absolutely.

And it was -- you know, we had the same friends.

And because I didn't talk about it for so long, we'd still bump into each other in social situations and mutual friends.

So I started slowly letting people know, and it was kind of -- it was before #MeToo, so people were confused.

They had -- there wasn't a lot of discussion about this... -Yeah.

-...you know, anywhere.

It was something to be swept under the rug.

-And women were kind of blamed that they brought it on themselves, to the point that you probably believed that.

-Yes, absolutely thought I just wasn't strong enough to take control of the moment and that it, you know, was my fault.

-So, how would you describe your general mental health, you know, and level of anxiety, fear?

Were you still having panic attacks?

-Yes, so I had been fainting a lot at that point.

So, I was fainting before the sexual assault, often.

I was disassociating in class when I'd be stressed, I noticed, and I don't know if I was having a panic attack, 'cause it didn't feel like the other ones, but I would kind of disassociate to the point that I would, like -- I would fall down sometimes.

And I'd faint in public.

I'd faint if I was too hot.

And that was also -- I wasn't sure if something was wrong with my heart, so I'd been in the doctor back and forth for that kind of -- for testing, and so... -You must have been always fearful that it would happen at any minute... -Yeah.

-...and also about what was happening to you.

If she -- as a primary care physician, Julie walks into your office and you hear all of this... -Yes.

-...what would you be thinking?

-So, that's a complicated history 'cause there's traumatic events, the concern for PTSD, as Dr. Watkins was referring to.

There is panic attacks as well.

There's a level of anxiety that's elevated.

She's got a number of issues that are going on that are raising concern about kind of an overlapping syndrome with her, in my mind.

So, you know -- -She fortunately did -- you finally went to your doctor and told him -- her.

I think it was a female doctor.

-Yes.

I had a new primary care physician, and I talked to her for a few minutes.

She heard the cadence of my voice.

She saw my, you know, physical demeanor and the way I was nervous and stuff just explaining it.

Told her what things had happened 'cause that wasn't actually my first and only sexual assault.

So there was other things, too, when I was younger.

-You had others?

Oh, my gosh.

So this is all adding up.

-Yes.

-So, younger when you were a child?

-Teenager, teenager.

So, yeah, it wasn't my first time, and it was just the worst one.

It was one that, you know, hurt the most.

-Pushed you over the edge.

-Right.

So I went and met with her, and she listened to me for a little bit, and she just took her glasses off and was like, "So, you have generalized anxiety."

I was like, "Oh, all right."

I never thought of myself as, like, an anxious person.

I just thought I was having these moments.

But the moments happened more and more.

-But it was an actual diagnosis.

Can you explain, Dr. Watkins, what that is exactly?

-Sure.

I just wanted to go back, though.

It's all too common that when people have these experiences that you describe, that they kind of suffer in silence for a very long time before they seek help, which, you know, an incident like that will shake you to the core where you do start to feel guilty.

You put into question your self-esteem and your confidence.

And so these things are just so important to be able to kind of put on the table and talk to your primary care doctor or your therapist about.

And I'm so glad that you were able to do that.

-Thanks.

-So, generalized anxiety disorder is really common.

It's really just this kind of persistent worry, someone who just worries about everything, a lot of future-oriented worries.

They get trapped in this "What if?"

loop, and so it just takes over them, and they are unable to really focus on the here and now, and so they're constantly in a state of heightened arousal, constantly feeling like the world around them is not safe and dangerous.

There are so many different fears, and you only really know what they're afraid of is when you ask them.

You have to ask them specifically, "What are your worries?

What are your fears?"

And that's how you kind of get to the core.

And then you're able to kind of create a treatment plan for them.

But it's really complicated, especially when it's layered with so many other things -- the losses, the traumas.

It can be really complicated.

-Because there are other anxiety disorders, and talk about how they differ, but also how they intersect, you know, the phobias and fears that can come about in the panic attacks.

A lot of them all kind of work together, right?

-So, a lot of them run together.

So, often generalized anxiety and social anxiety and separation anxiety -- they all tend to run together.

Typically, you see separation anxiety and social anxiety in children and adolescents.

And then in later adolescence and in early adulthood, you begin to see generalized anxiety and panic disorder.

It's rare that you see someone that just has one -- one anxiety and not another.

-Interesting.

Yeah, it's common to hear all of this anxiety these days from your patients.

Are there certain people that are more likely?

I guess I'm asking, what are the risk factors?

-Right, so, I mean, some people are high-risk.

There's -- a family history can very often be seen.

-So, genetics is a big part?

-I see a lot of family history of anxiety disorder.

And whether that's genetic or it's just part of family learning, we don't know.

-Oh, learned behavior?

-Right.

Learned behavior, right.

-Let's face it -- a lot of people have just anxiety.

-Sure.

-But Dr. Watkins, when is it actually something, a disorder like the generalized anxiety disorder?

When do you cross that line?

-It's when it gets in the way of living, when it gets in the way of your life.

You're unable to do things that you need to do and unable to do things that you want to do because of the anxiety.

It just becomes all-consuming.

So you just can't even -- some people are so anxious and so trapped in the loop of the "What if?"

in the future they can't even make decisions, so kind of that whole paralysis by overanalysis situation that you see in a lot of younger kids.

-We got a head shaking here.

"Paralysis due to overanalysis."

Is that what -- kind of what it feels like?

-Sometimes, definitely.

-Constantly?

And the research shows us that millennials are experiencing more anxiety than any other generation.

How do you see why that's happening?

-So, I think there are a lot of reasons why they would be experiencing more anxiety.

So, in part, I think it's due to the fact that the expectation versus the reality -- they don't match.

So, you expect people of the next generation to be doing better than the people of the previous generation, and that just hasn't panned out.

But there's just so much uncertainty in this world that we live in today that they find themselves worrying about, again, job security and finances.

They're a highly educated group, and they have tremendous student loans.

But even aside from those things, there are a lot of issues that we're dealing with.

There's a lot of unrest.

So they're, you know, concerned about climate change and global warming and health and whether they'll have health insurance with the Affordable Care Act in the balance.

They're worried about how they'll make their ends meet.

Will they have to return home?

There are just so many things that they're worried about.

And this is a really vocal group.

They don't just stand by and let things happen.

So, they are taking up issues around race and racism and Black Lives matter and #MeToo and so many things.

There are so many things that are on their shoulders.

They have a lot to be anxious about.

-Yeah, it's kind of like the weight of the world, and we can't ignore that this is the tech-savvy generation.

-Yes.

-But is it also because, like, you're constantly kind of being judged by what everybody else is out there doing?

-Right.

I mean, I think what adds to it, as Dr. Watkins is saying -- you have all this going on, and you're constantly reminded of it, if not through social media, through, you know, news links, through texting with one another.

You know, there's this barrage of, you know, of you being -- you're basically in this test tube being evaluated all the time.

-Your world is being shaken.

-Right, it's being shaken.

But you're being evaluated all the time at the same time, right?

You know, growing up in the age where I was before all this technology, there was ways to get away, right?

I don't know if your generation really gets to do that.

-No.

-Well, because you're always -- you're the millennial.

-Yep.

-So tell us, how are you experiencing -- why do you think that this is the most anxious generation ever?

-Well, the world's on fire.

We have all of these issues we're trying to care about, and we want to do the right thing and we want things to be better.

And there's a lot to fight against in doing that.

And social media can be a great tool.

It can also be incredibly divisive.

It can be really fun.

It's an awesome thing.

I love social media, but I also, you know -- it's like there's too many decisions sometimes on what you need to care about and what you need to think about.

-That's a good way to put it.

-Yeah.

-And when you're already concerned and thinking about what's going on in your own life and your friends' lives, and, you know, we're also worrying about our friends' lives, and -- -Sounds like you're worrying about a lot of stuff.

-Yeah.

-Worrying about a lot of stuff.

-Well, sometimes it's hard to ask for help.

But, Dr. Watkins, what is the help?

What do you -- what's the treatment for this?

-So, what's fortunate is that anxiety is really, really responsive to treatment.

There are a lot of great treatments out there, and only really one third of the population who has anxiety gets treatment.

There are some therapies that are available.

The most common one is cognitive behavioral therapy, which is where we teach that there's a connection between your thoughts and your feelings and which drive your behaviors.

For instance, if I see a dog, I might think, "Oh, that's a cute dog," and I feel happy, and I might want to go over and pet the dog, versus if I see the dog and I think, "Oh, this vicious animal."

I feel afraid and I want to run.

So they're are connected.

My thought, my feeling, you know, dictates my behavior.

There's another therapy that's similar to CBT, which is called Exposure Response Prevention Therapy.

Well, basically, it's the gradual desensitization of whatever that feared outcome is.

So, we gradually expose you to something that you're afraid of in baby steps and in increments until you get to the point where you have faced this fear and you no longer feel afraid of it.

It kind of takes the wind out of the sail, more or less.

The other thing that people do that use -- that they use for anxiety is meditation.

Meditation is the practice of being mindful and bringing yourself to the here and now, which, again, we think about this loop of the future and the "What if?"

You know, meditation is really good to ground you.

And then, of course, there are medications.

So, when the therapies don't -- aren't enough, I'll say.

I won't say don't work.

I'll say they aren't enough.

You can add medication to the regimen.

Medication has to be done after consultation with a doctor.

It has to be part of a comprehensive evaluation, and it has to be part of a greater treatment plan because pills aren't skills, so you still will need the therapies and the skills and strategies to manage anxiety.

-So, Julie, what's been your treatment?

What's been going on?

-Okay, so, my -- the same doctor who diagnosed me, I -- her and I were talking about medications 'cause she had immediately given me a Xanax prescription.

And I know what that is, and I know how addictive it is, and I know the long-term effects.

And I wasn't really thrilled.

But it's kind of like a ripcord for me.

If I'm mid-panic attack or, you know, I look at whoever I'm with, who I trust, and I say -- now I say to people, "I'm having anxiety right now.

Can you either, you know, stop talking to me for a second and give me a moment or hug me, or can we leave the room?"

And if it doesn't de-escalate and I get to the point where I'm, you know, on the kitchen floor crying, sobbing, in pain, you know, "Can you please go -- can I go grab a Xanax?

Can you run and get my purse?"

Then it's like, yeah, 'cause that's like a ripcord.

It's like the little safety vest that puffs up -- -Break glass.

-Yeah, break glass and sit down and wait till you can breathe and... -Yeah.

-...and then talk about it and, you know, reset.

-Lou, as the doctor, I mean, talk a little bit about what group of medication Xanax is in and what those medications are that do have addictive and long-lasting effects.

-We have medications for a reason, and they have useful interventions for certain conditions.

Xanax is in the family of benzodiazepines, and benzodiazepines are anxiolytics, they call them, or, you know, they can be sedatives, and they're used in that realm.

The problem with benzodiazepines is they're very addictive.

And my own personal feeling -- they make me more nervous than opioids.

And the getting off of them is difficult.

So I don't like to see people on it on a daily basis.

It's not to say that there are people that aren't.

If I do have people that need to do that, I am working with someone like Dr. Watkins 'cause that person is very complicated, and I want to have that professional assistance in that.

But they are useful drugs, but they're not my go-to first drug for treatment other than in that ripcord situation, and I very carefully counsel them on that.

But, again, you know, that's part of a bigger treatment plan.

-Has that been really what's helped the most?

I mean, you have your ripcord meds.

-I have my record meds, but therapy has been wonderful.

-Dr. Watkins, as a psychiatrist, what are the most important takeaways here that primary care physicians should know when they have patients come in to them with generalized anxiety disorder?

-So, I guess first the -- to remember that it's so common and so we should be looking for it.

So early detection is important so that we can begin treatment early.

The second thing I would say would be, you know, really take time to determine what is the biological kind of basis.

You know, anxiety typically comes to primary care first because there's so many physical symptoms, and you want to make sure that there is nothing there that needs to be addressed other than the anxiety before you start the anxiety treatment.

And the last thing would be really know the range of options for treatment because, like he said, medication is not the first line for treatment.

Medication should be considered when symptoms are moderate to severe, but before that, there are many other steps before you can get to medication.

So really know what the options are for medication and actively treat, because, again, there's long-lasting effects when people have anxiety and they're not treated.

They don't get into school.

They maybe don't go off to college.

They can't keep a job.

It just really affects their whole life.

So, really, the treatment is key.

-Lou, you are the primary care physician.

I think that there's such a tendency to go straight to meds.

-There is, yeah.

And some of that is practical.

What Dr. Watkins is getting at -- very often by the time they come to us, they're pretty advanced in their symptoms.

And I actually like to use some of the questionnaires because it objectifies it for the patient.

Lots of times they're very reluctant to hear the diagnosis.

But when you use those questionnaires with points and you say, "This is how you are," it really helps with that.

-Julie, knowing what you know now, what would your advice be for someone who's just being diagnosed with an anxiety disorder and is grappling with it?

-Find a therapist.

Don't wait.

I didn't get my therapist until a year ago.

I'm 29.

-And you're 29.

So you have been struggling with this for so long.

-Yeah, definitely.

So, yeah, 'cause you just -- you just kind of have to keep your life moving, you know?

And panic attacks come and go, and you might think you're fine for a while, and you might be fine for a while 'cause it's -- you know, when you get a diagnosis, you tend to over-relate to it or you -- -Overthink it.

Yeah.

You overthink it, and you over-identify with it.

And every little thing you hear, you're like, "Oh, is that me?

I guess that's me, too."

And you start, you know -- you start believing everything.

And then your head just makes up these really entertaining and horrifying story lines for yourself to believe.

And, like, that's -- one of the worst parts is, like, you know, intrusive thoughts.

Sometimes you think that they're your genuine, real beliefs and thoughts when they're actually, like, anxiety, you know, lying to you, making you believe that you're in danger, making you believe your friends don't like you, making you believe people are, you know -- I've had friends who think that there's people talking about them at the booth next to them at the restaurant because they're insecure about whatever's going on in their own heads at the moment.

And therapy's awesome, and it's nothing to be afraid of.

And find a good one, and don't be afraid to leave one if you don't like them.

-Oh, another -- that's also good advice.

-Yeah, like, some therapists -- -It's got to be what they call a therapeutic relationship.

-Right.

-It's got to be a good therap-- You got to connect.

You got to feel comfortable talking about the things you're talking about.

-Yeah, trust them.

-You don't want them kind of, like, sifting through their e-mail... -Yeah, right.

-...when you talk to them.

Don't be afraid.

You're driving the bus.

-Yeah, find a good therapist.

Talking to your friends, letting them know what your triggers are, not being -- you know, it takes a long time to stop being embarrassed of it, but once you do, you can gain a little more control.

-Well, Julie, I just thank you so, so much for coming on here, telling us your story, being so open about it.

You've painted a picture of how debilitating anxiety can be for some people.

-Thank you.

-And Dr. Watkins and, of course, Dr. Papa, thank you both so much.

And thank you for watching.

Find more information about the series at secondopinion-TV.org.

You can also follow us on Facebook and YouTube, where you can watch today's episode and much more.

From all of us here at "Second Opinion," we encourage you to take charge of your health care.

I'm Joan Lunden.

Be well.

♪♪ ♪♪ ♪♪ ♪♪ -When our communities need help, Blue Cross and Blue Shield companies step up with partnerships capable of preparing meals for thousands of families in need, because it's not just about health insurance.

We believe it's our responsibility to expand care to rural communities, protect our heroes with safety equipment, support local nonprofits.

These are our stories to help build stronger communities for the health of America.

-"Second Opinion with Joan Lunden" is produced in conjunction with UR Medicine, part of University of Rochester Medical Center, Rochester, New York.