Many people describe anxiety as an out-of-control feeling, like being a passenger in their own life rather than the driver.

If you’ve ever felt this way, you’re not alone. And more importantly, you’re not powerless.

As a physician, I see this pattern repeatedly: A sensation of helplessness triggers anxiety, which then creates more feelings of being out of control, perpetuating a difficult, spiraling cycle. But understanding the fundamental connection between control and anxiety is the first step toward breaking free.

The Two Sources of Anxiety: Internal and External

The great majority of anxiety we feel stems from conflict, either internal or external.

Internal conflict comes from our own thoughts, creating scenarios that don’t actually exist yet. We dwell on what could happen. Someone makes an offhand comment, for instance, and we assign enormous weight to their words, imagining worst-case outcomes that may never materialize.

External conflict starts from the reality around us. A check bounces. The IRS sends a letter. Your employer announces layoffs. You have a terrible fight with your significant other. These real events create understandable anxiety because they involve genuine loss of control, creating feelings of helplessness or hopelessness about what comes next.

But here’s the secret: It’s not the internal thought or external stimulus itself that determines our experience. It’s what we do with that trigger that determines whether we spiral out of control into anxiety or we receive it as a challenge to navigate, a lesson to learn, or simply a part of life we need to ride out.

Control and Anxiety: Common Triggers

Let’s walk through several real-life examples where perceived loss of control causes anxiety to escalate.

Scenario #1: Paging Dr. Google

You’re experiencing some bothersome symptoms, so you do an internet search. You come across the usual websites, and within minutes you’re convinced you have a terrible disease.

The problem here isn’t that research is bad, but that without context, it’s easy to jump to the worst conclusion — even if it’s highly unlikely.

My job as a physician is to think “common things are common.” I always consider worst-case scenarios to ensure I’m not missing anything serious, but I don’t dwell on them. When patients get health advice without the contextual filters of medical training and objectivity, it’s incredibly difficult to determine what’s important and what’s not, what’s likely and what’s not.

This is one reason I’m so happy to practice medicine in a format where my patients can reach out to me any time they have a concern.

Scenario #2: Work Interruptions and Time Management

You’re focused on an important project at work when a colleague approaches. “Got a minute?” they ask.

They aren’t just trying to chat; they genuinely need help. But this pulls you away from efficient use of your time. The interruption could prevent you from meeting your deadline, so anxiety climbs while your sense of accomplishment and job satisfaction plummet.

In these cases, instead of stopping immediately to address your colleague, I suggest responding with, “I’ll be with you in about 20 minutes — I’m just finishing up this project.” Or ask, “Is this urgent? If so, I can stop now, but otherwise, I’d like to finish what I’m working on first.”

If your boss is the one asking for that minute, try this approach: “I’m in the middle of the task we discussed for today. I’m happy to switch to something else if you prefer. Which one is more important right now?” This doesn’t require saying no to the person who signs your paycheck, but it allows them to prioritize your time appropriately while keeping you from anxiety about unmet deadlines.

Scenario #3: Micromanaging Children

Control and anxiety often operate as two sides of the same coin in family life as well.

When our kids are small, they need so much from us, and we control their environment and actions to a great degree. This keeps them safe and fosters healthy development.

But as they grow and become more independent, our children need different types of supervision.

The book Teen-Proofing, which I’ve written about previously, shares a helpful concept: Tying a “rope” to your child allows them freedom to grow but allows you to rescue them from falling off a cliff.

When we stop ourselves from micromanaging, we reduce our children’s anxiety and give them space to develop into responsible adults. Yes, this may create temporary anxiety for us as parents because we’re not controlling every detail. But the trust that builds through this freedom — in us and in them — actually lowers everyone’s anxiety over time.

Distinguish What You Can and Can’t Control

Regarding external triggers, it’s important to remember that something being genuinely out of our control doesn’t mean it has to result in anxiety.

The Serenity Prayer from Alcoholics Anonymous is useful here: “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

This doesn’t just apply to those struggling with chemical dependence. It applies to everyone and in every area of our lives. In fact, that single sentence is a manual for managing anxiety.

Elements of life fall into two categories: things we can change and things we can’t. For the former, we need the courage and wherewithal to take appropriate action. For the former, we need acceptance. Perhaps most importantly, we need wisdom to distinguish between the two.

When we lose sight of this difference, or lack the ability to distinguish between the two, we either try to change things that are unchangeable (leading to frustration and anxiety) or believe we can’t change things that are actually within our power (leading to helplessness and anxiety).

Reclaim Your Sense of Empowerment

When you identify what you can control, you gain a sense of empowerment and realistic expectations about what will likely occur. This allows you to establish routines and make conscious choices about your health, nutrition, fitness, and emotional well-being.

The key is focus. In a favorite book of mine, The ONE Thing, the author references a quote from Confucius: “The man who chases two rabbits catches neither.”

This refers to the impossibility of true multitasking. Even the fastest computer processor — a machine that can search the entire internet — operates on collections of zeros and ones, completing tasks one at a time at super speeds.

Our brains work the same way. When we try to do two things simultaneously, we don’t succeed in doing either to the best of our ability. It only makes sense that “multitasking” and being pulled in different directions would cause us to feel out of control and anxious.

To combat this, bring intention to your day. Focus on what matters most. Make conscious choices within your control.

Don’t overwhelm yourself by trying to catch multiple rabbits at once.

When Anxiety Requires Professional Help

At times, anxiety can become so severe that professional support is necessary. Here are some key signs it’s time to seek help:

• Friends and family express concern. If people repeatedly ask, “Are you feeling okay? Something doesn’t seem right,” they’re probably seeing something you don’t.
• Physical symptoms appear. What physicians call somatization occurs when anxiety manifests as physical symptoms: abdominal cramping, diarrhea, rashes, musculoskeletal pains (especially neck and lower back pain). If these symptoms appear without a clear cause during stressful periods, anxiety may be the underlying culprit.
• Daily functioning is impaired. You can’t complete tasks you normally handle. You’re overeating or undereating. Sleep disturbances develop. Relationships suffer.

When you mention these symptoms to someone, you might be tempted to throw up defenses if they suggest anxiety as the cause: “It’s not in my head!” But remember that these symptoms can stem from your anxiety and your perceptions. That doesn’t make them any less real; it just provides you with the proper route to address them.

An appropriate physician will rule out biological problems while keeping anxiety and mental health in the differential diagnosis. It’s not the first thing we think of, but it must be on the list.

Take Control: An Anxiety Action Plan

If you feel that sense of helplessness creeping in, here are a few helpful steps I often recommend:

Start journaling. For anxiety specifically, start a gratitude journal. Write down your accomplishments — what you’ve done to raise a family, a degree you’ve earned, a positive habit you’ve built, stressors you’ve successfully eliminated. Review everything, small or large.

Take inventory of your commitments. Are you on boards or committees that create more anxiety than benefit? Being on your homeowners association or a local organization’s board isn’t an unimportant activity, but if it results in anxiety that outweighs its benefits, it’s time to reassess.

Simplify complexities. Some people thrive in a packed schedule, juggling multiple activities. Others feel best with more focused pursuits — maybe a tennis club — while spending other days reading a book. Taking on too many time commitments that don’t align with your natural rhythm surfaces that out-of-control, anxious feeling, along with all its physical symptoms.

Control and Anxiety: Final Thoughts

Remember: You are not powerless. Understanding what drives your anxiety and distinguishing what you can control from what you can’t is the foundation for reclaiming your calm. And if you need professional support while doing so, that’s nothing to be ashamed of.

We all need help at different times, whether it’s with anxiety, an illness, or something else. What’s important is that we seek the help we need when we need it, rather than trying to push through alone.