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How to Handle Anxiety at Work

wellness, Real Talk, PopularMaría Elena RodríguezComment
how to handle anxiety at work

After the success of Dr. Cristina Rosario PhD's first interview about anxiety, we decided to write a part 2 of that post. This time more focused on anxiety in the work place.

With that said, if you wish to know more about what is anxiety and all its components, go read that blog post first, here. Now that you know the basics but you are looking for ways to ease your anxiety and panic attacks at work, here are some tips and tricks: 

What are the signs to identify an anxiety or stress problem at work?

There are many anxiety signs and they could vary from person to person. Even though many people reflect physical symptoms and dysfunctional thoughts, it is understood that work anxiety could be reflected in an indirect form. If you are in a work environment where you are being observed and evaluated, your anxiety could be hidden. The need to suppress this physical response opens the door to an internal and biological anxious response. For example. you could experience stomach aches, asthma, dermatitis, psoriasis, muscular pain and even changes in your blood pressure. 

Other signs of work anxiety are lack of concentration and motivation, frequent visits to the bathroom and or kitchen, talking too much with co-workers, isolation, avoidance and the increase or decrease in appetite. It usually comes with a combination of negative, dysfunctional, self-doubt, catastrophic and insecure thoughts in addition to physiological responses such as reflux, stomach aches, spasms, hair loss, nail biting and tics. 

What should you do if you a feel panic attack at work? 

You should take these four steps:

1. Ask yourself if your life is in danger. It doesn't matter where you are, you should always ask this question, since it will help you identify if the response you're experimenting is adaptive or pathological. If your response is affirmative, your symptoms are tools for survival. If your response is negative, your response was pathological, which means it was linked to mental health. 

2. Ask yourself what is causing this response. The answer will be your mind and you should remind yourself that if you have the power to activate this response, you have the power to stop it. This has so much value because it helps you have an active role towards finding a solution to manage your anxiety rather than being submissive or play victim. 

3. Breath in a controlled and profound flow, inhaling and exhaling slowly through your nose. Your breathing will pause your anxious response, sending a signal to your brain that you are in control and are able to control your body if you set your mind to it, so you can proceed to the fourth and last step. 

4. Identify the irrational thoughts that responded in a panic attack. Thoughts like "I am a disaster, I will not make it, they called my attention again, nobody understands me, I can't handle my supervisor, he doesn't think I'm competent, etc.". Once you identify these, you can proceed to ask yourself (1) What happened in my environment that ended in these thoughts? and (2) how could I argue with these response so it stops happening? 

panic attack treatment

What would you recommend someone who just entered the workplace and is learning the hard truths about people and life? 

Life is about getting ahead. Sometimes going upstairs, sometimes skipping holes, running as fast as you can and sometimes simply maintaining a firm and constant pace. Each developing stage represents a challenge and a lesson. The transition from teenager to adult is so complicated because it suggests a change in responsibilities, expectations, lifestyle, decision making, independence and autonomy. I think that the right strategy should be to assume an active role where you see conflicts as situations to fix instead of catastrophic events. 

Once you finish school is your time to grow experience wise. You should give yourself space to learn so you can understand processes and functions. Every situation and person is not an obstacle, they are an experience that will provide you a lesson. For example, a difficult boss will teach you to control impulses, organize your thoughts and express them with an assertive tone of voice.

Eventually you will learn to separate work and life, stand up for yourself and most importantly, your value. If you are not valued in your work environment, that is not the place for you. 

There is still a taboo towards anxiety problems at work. Do you recommend we tell our supervisors about our mental health issues? 

I have been in my private practice for around 5 years now and I have never written an absence notification for a patient. Sadly, mental health in Puerto Rico isn't something that is talked about and if we do, it is seen in an ignorant way. 

I believe that mental health should be perceived in the same way as physical health. Both should be attended promptly if we want to enjoy a favorable and healthy quality of life. One nurtures from the other one, nevertheless, mental health is tainted with discrimination and a misconception about it being a sought out disease. 

So my answer is yes, you should inform your superiors about your mental health issues, in order to stop the stigma and discrimination and show people that even though we may need some help with mental health, we may still be functional, capable and responsible human beings. You may also gain access to reasonable accommodation that could favor you and the company you work for. 

Nevertheless, you should disclose this information with your supervisor and/ or human resources manager, not your office friend. The notification should be made confidentially and should never justify inappropriate behaviors. It should only alert management about your condition and let them know you are seeking help. 

Should the Human Resources Department be aware of our anxiety problems? 

I believe they should, since this department is an employee's tool to guard their rights and confidentiality. Even though this is not my expertise, I know that there are laws that protect the employee when it comes to treatment, like for example the "Employee Help" or PAE program, which provides mental health services to employees without an additional cost. 

If your condition is not stable and you are experiencing evident dysfunction in your job, the responsible thing from Human Resources would be to retire you from the work environment and offer a space without penalty where you can receive the required treatment level. 

How should we manage stress or anxiety when the main trigger is a co-worker?

You should always manage triggers by confronting them. If you avoid them, it could give phobias and fears a green light. 

Once you identify a person as a trigger, the next step is to explore and evaluate the emotions that this person causes, and not just good or bad. It is highly probable that this person turns on previous negative associations, specially, personal insecurities or traumatic experiences. 

The moment you understand the emotion and thoughts behind the triggering, we can reflect if the situation is real or if you are perceiving something personal or direct to what it really is. You need to force a critical and operational thought. Once you have self reflected and organized the data, you should use assertive communication and appropriate channels to express yourself. Language plays a very important role here! 

1. Point out to what makes you feel uncomfortable

2. Acknowledge the emotions associated with the event

3. Try to empathize with the other person

4. Establish possible consequences to their actions

5. Generate possible alternatives towards an effective solution to the situation

6. Listen

7. Negotiate

8. Act

9. Reach new agreements

Given that this situation is contextualized within a work scenario, it is important to emphasize the importance of the "appropriate channels". It is important for this type of conversation and confrontation to take place within a professional setting, such as in the human resources office, in the conference behind closed doors, in the presence of another supervisor. Never in front of other employees, during lunch or in a social activity.

One of the biggest professional challenges is managing a person or team for the first time. How can we effectively supervise someone with anxiety symptoms? 

First, you must maintain a professional attitude and recognize that your role is to educate, supervise and ensure quality of work. Communication must be assertive and firm, it should be clear what the expectation is and what the process or action plan is to execute it.

A receptive and emphatic space should be offered, where the person feels comfortable expressing her/himself. It is recommended that the supervisor meets with the person on a regular basis. Open-ended questions should be asked, where the other party is encouraged to think and justify their thoughts; suggestions are validated with theories and/ or facts.

Many times people become anxious at work as they have multiple tasks simultaneously. The role of supervising someone anxious is to operationally define the problem, the expectation, and help the person learn to set priorities, structure and work plan. Another role should be to be able to identify the strength and areas to improve the anxious person, exposing and challenging her/him to her/his development. You should always try to get the person exposed to the situation, versus avoiding it. However, you can be emphatic and lead the person to a gradual exposure, where you initially serve as a model.

What is the best way to manage the fear of public speaking, speaking up in meetings and even interactions with peers? 

When it comes to public speaking:

1. Master the subject. 
2. Recognize yourself as the expert on the subject. 
3. Feeling confident that you are going to talk about what you know. 
4. Practice before giving the presentation, first individually recording with the cell phone or the camera of the laptop. Then make the presentation in front of a colleague or friend. This allows you to evaluate your posture, your tone of voice, your projection and the time it takes you to do it.
5. Visualize yourself making the presentation in a successful and positive way. Make positive self affirmations such as "I will be perfect, I will be able, I am good"
6. Be sure that the questions are answered or the material is understood.
7. Have a bottle of water or some candy.
8. Control the environment.
9. Arrive on time and leave everything ready at least 30 minutes before. 
10. Make a check list of the materials (that the computer loads, battery, projector, pen drive materials, etc.).
11. Make deep and slow or better known breaths like diaphragm and muscle relaxations prior to the beginning of the presentation.
12. Smile, if you are wrong, stop, breathe deeply, drink water, and take up the subject.

When it comes to meetings:

Remember that the unknown gives us the anxious response. Therefore, a useful tool for combating anxiety in a meeting may be to ask fpr the agenda to the supervisor or manager on the issues to be discussed. Knowing if there is any dress code or what is expected of me during that meeting will help ease anxiety.

A lot of people under perform at work due to personal issues. What advice will you give someone who is going through this?

Seek for help and educate yourself about mental health services. Mental health is not synonymous with hospitals of psychiatry or pills, it's the opposite. Once you recognize that something is causing you discomfort, seek to solve it through dialogue, the expression of emotions and changes in behavior. Understand that mental health, should be something preventive, something beneficial and not something stigmatizing. Accept that learning comes from experience and that mistakes are opportunities. Understand that success comes from being able to solve what you have to face, to learn to attend to priorities, to have the ability to adapt to different scenarios and situations, to learn to successfully manage emotions and thoughts, to see the positives of closing circles, to understand that they have multiple roles in the same life and that sometimes the most healthy and wise thing to do is to ask for help.

How can we cope with loved ones who just don't get mental health? 

We should identify the situation ourselves and look for help in order to restore organization. Once you believe and empower yourself among your resources, then you can educate and defend mental health as an issue. We should promote mental health as a preventive, important and central aspect of our well being for optimum functions. 


Call 911 and visit your nearest hospital. It can be a regular hospital since the person will eventually be transported to a psychiatric hospital. 

We should NEVER assume that the person is being manipulative and we certainly must never assume that the "suicide is trending" as I read in a comment related to 13 Reasons Why. 

Here are some health care providers (in Puerto Rico) to consider if you're having sucide thoughts or in case of an emergency: 

  • Suicide Prevention Lifeline – National Network (TALK): 1-800-273-8255

  • Centro de Control de Envenenamiento (Poison Help): 1-800-222-1222

  • Administración de Salud Mental y Contra la Adicción (ASSMCA), Línea de Emergencia Primera Ayuda Social (PAS): (787) 763-7575/ Toll Free Number: 1-(800)-981-0023


  • Hopital San Juan Capestrano

    • (787) 760-0222 (exts. 7162, 7163, 7196 y 7197)

    • fax (787) 760-6875 y 760-2944

    • Toll free number: 1-(888)-967-4357

  • Hospital Panamericano en Cidra

    • (787) 739-5555 - (fax) 739-5544

    • Toll free number: 1-(800)-981-1218

  • Hospital Pavia

    • 787-641-2323

  • Hospital Ramon Fernandez Marina

    • 787-766-4646

Partial Adults:

  • Hopital San Juan Capestrano Bayamón / Condado

  • Hospital Panamericano en Cidra

  • Inspira Auxilio Mutuo / Hato Rey / Caguas / Bayamón

  • APS Healthcare Inc, Caguas y Carolina


  • Hopital San Juan Capestrano

    • 787-625-2900

  • Unidad Psiquiatrica Adolescentes -- Instalaciones del Hospital Universitario Ramón Ruiz Arnau(Hospital Regional de Bayamón)

    • 787-786-7373, 787-786-3620

  • Hospital San Jorge

    • 787-727-1088

    • 787-752-4453

Partial Minors:

  • Hopital San Juan Capestrano

    • 787-708-6324

  • Hospital San Jorge

    • 787-727-1088

    • 787-752-4453

dra. cristina rosario

If you would like to see Dr. Cristina Rosario, PhD (Clinical Psychologist) you can contact her for appointments here: 787-505-6938