Midlife Anxiety: Symptoms, Causes, and How to Cope

Midlife is a chapter of life full of growth, transitions, and stressors. Many individuals find themselves struggling with at least some degree of anxiety alongside increased demands, responsibilities, and life changes. 

Fortunately, there are many ways to understand, manage, and reduce anxiety in midlife. While you might always experience some degree of anxiety and stress (who escapes it?), it is possible for it to become more of a nuisance versus a monster. 

Let’s Start at the Beginning. What is Anxiety? 

Anxiety is a normal, healthy part of being human. Humans are wired to experience anxiety in situations that are novel or perceived as dangerous and/or or life-threatening. 

When all goes as intended, anxiety serves a protective function to keep us safe via the fight-or-flight response, which is the body’s automatic way of conserving resources by fighting or fleeing threats. 

Anxiety can also be motivating and help us prepare for action. In mild-to-moderate doses, anxiety helps us organize, plan ahead, prioritize, and generate solutions for potential problems. 

However, this normal, adaptive response system can easily go haywire, especially when the nervous system is already overloaded with other physiological and/or psychological stressors (we’ll get to those in a minute). 

Think about catching a flight at a busy airport to travel to an important event. Mild-to-moderate anxiety helps you prepare, double check your packing list, and give yourself plenty of time to arrive to the airport. 

Severe anxiety might get in the way of sleeping the night before, avoiding packing until the last minute, panicking over every detail, and generally not enjoying your trip. 

Anxiety skyrockets when we overestimate the likelihood of risk or danger while underscoring our ability to cope through difficulties. We might have other reactions to the anxiety itself (“what’s wrong with me for feeling this way?”), which can kick anxious thoughts into overdrive.

Anxiety Warning Signs 

Anxiety can look different for everyone. Understanding what anxiety looks like for you and your personal “warning signs” is a helpful starting point. 

Common anxiety symptoms include: 

• Feeling keyed up or on edge

• Trouble relaxing (and guilt when you do relax) 

• Constant focus on productivity 

• Irritability (feeling short-fused)

• Worries that are hard to control (doom spiraling)

• Preoccupation with “what ifs” 

• Restlessness

• Difficulty concentrating

• Overreacting to situations that typically would not cause stress 

• Trouble making decisions 

• Canceling plans

• Avoiding things you typically enjoy 

Anxiety Can Also Manifest Itself Physically:

• Trouble falling or staying asleep (3am wake-ups) 

• Racing thoughts

• Racing heart

• Fatigue 

• Muscle tension 

If you just found yourself nodding along with every bullet point on this list, please know that you’re not alone. 

Why Does Anxiety Spike in Midlife?

Put simply, there’s a lot going on during this phase of life. 

In addition to normative hormonal changes during perimenopause and menopause, midlife also often involves:

• Increased life responsibilities (so many people counting on you)

• Demands from parenting

• Caring for aging parents 

• Increased career pressure

• Shifts in friendships 

• Other physical health changes 

Any life transition creates stress - even one that is welcome, intentionally chosen, and exciting. The body cannot differentiate between “good” and “bad” stress; the nervous system simply marks it as stress. All of these factors (biological, social, and psychological) pile up, which is why anxiety often feels more intense during midlife.

Tips for Coping with Midlife Anxiety:

There are many ways of coping with anxiety. I encourage you to start with trying 1-2 of the strategies on the list, and see what works for you. 

1) Breathing skills. 

This is a quick and effective way of coping with anxiety. Breathing is the only physical function you can directly control, and focusing on the breath automatically re-focuses the worried mind back to the present moment. 

Box breathing can be especially helpful. Inhale to the count of four, hold for four seconds, exhale for four, pause for four. Repeat this continually for a few minutes. 

You’ll find that your anxiety doesn’t magically disappear, but it can:

- Reduce the severity of anxiety

- Quiet anxious thoughts for a little bit

- Give you a quick mental reset

It’s ideal to practice this for at least a few minutes every day, regardless of how anxious you’ve been feeling. The more you practice, the more benefit you’ll be likely to notice. 

2) Check the unhelpful thoughts and worries.

Anxiety is a sneaky charlatan that constantly comes up with potential worst-case scenarios and endless “what-ifs.” Anxiety causes us to overestimate likelihood that the worst-case scenario will happen, and underestimate our ability to cope through tough times. 

When you notice your mind spinning stories about the future, pause and gently question them. 

Is this thought a fact, or a fear? What evidence supports it, and what evidence doesn’t? 

Simply creating a little space between you and the thought can take away some of its power. You don’t have to eliminate the worry entirely, but just noticing it for what it is (a thought rather than a certainty) can help you keep your head above water. 

3) Rework your relationship with anxiety from resistance to acceptance.

A lot of people shudder at the term “acceptance” because it conjures images of giving up and letting go of control – and oh, how anxious people love control!

Acceptance is actually quite the opposite – it’s an active, intentional process by which we allow things to be just as they are. It’s not the same as wanting or liking. 

Sometimes the things we do to “fix” or resist anxiety work for a little while, but then end up making anxiety much worse:

• Online shopping

• Drinking alcohol 

• Canceling plans

• Doom scrolling

• Self-criticizing 

Think about being stuck in quicksand. The initial response might be to try to pull yourself out as quickly as possible, which ends up making you more stuck. The way to escape quicksand is to stop struggling, increase your surface contact with the quicksand, and gently move forward. 

Acceptance works in much the same way. When you stop fighting anxiety and instead notice, label it, and allow it to exist without judgment, you create space to move more freely. This allows opportunity to respond versus react, and to increase self-compassion. Acceptance can loosen the tight grip that anxiety has over your life. This takes practice!

4) Schedule worry time. 

Scheduling worry time involves setting aside 15-20 minutes in your day to intentionally write out your worries. It sounds paradoxical at first: “I’m trying to get rid of worries, so why am I worrying on purpose?” Trust me, this one can work – and is one of my favorite anxiety coping skills.

There are a few reasons why this coping skill is effective. Worries tend to pop up all day long and occupy a lot of brain space. By having scheduled time to worry, you can simply file it away for later and move on with your day. Scheduling worry time helps consolidate anxious thoughts to a finite amount of time per day.  

There’s also benefit to the act of writing out worries. Journaling can facilitate emotional processing, provide clarity, and help you identify potential solutions to problems. Writing can also help you figure out which problems are solvable, and which ones might need acceptance. 

Try to schedule worry time for the same time daily. Avoid doing this exercise right before bed, as this exercise can be activating. Set a timer for yourself for the 15-20 minutes. Pair with breathing skills to regulate as needed. 

5) Seek out support. 

I envision anxiety like holding a beach ball underwater. When accompanied by other emotions such as shame (“other people have it figured out… what’s wrong with me?”), it becomes harder to keep the ball underwater. It requires an increasing amount of focus and pressure to keep it under the surface, yet it ends up shooting up anyways. 

Sharing how you are feeling with someone you trust is a way to let some of the air out of the beach ball. Being met with validation, understanding, and compassion lets the air out even further. 

Seek Out Professional Support as Needed

If you are having problems with anxiety that are getting in the way of daily life and/or causing high amounts of distress, consider meeting with a therapist who specializes in midlife anxiety, such as myself, for professional support. 

Therapy is more than simply talking and venting. Working with a professional can help you:

• Clarify what matters most in this phase of life

• Gain insight into your thoughts and emotions

• Learn how to interrupt unhelpful thought spirals

• Build a repertoire of healthy coping skills

• Feel supported as you navigate life changes

Many individuals also benefit from medication management for anxiety. Medications such as antidepressants, anti-anxiety medications, or certain hormone-related treatments can help regulate mood, reduce physiological symptoms of anxiety, and support other behavioral coping skills.

Conclusion

Though it is common for anxiety to spike in midlife, you do not need to suffer in silence. Anxiety is the thief of joy in that it pulls us out of the present moment and into the future, but with awareness, support, and practical tools, it is entirely possible to reclaim your sense of calm and connection to the here and now.