Anxiety in the legal profession

Lawyers frequently complain of anxiety. Stress in the legal profession is well known, including the adversarial nature of the court system, demanding schedules and heavy workloads. In a recent landmark study conducted by the ABA Commission on Lawyer Assistance Program and Hazelden Betty Ford Foundation, 19 percent of attorneys reported anxiety, mirroring its prevalence in the general population. The Survey of Law Student Well-Being found 14 percent of law students experienced anxiety. 

Though anxiety is the most prevalent mental health concern, it is underrecognized and undertreated. The most common forms of anxiety are panic, generalized anxiety, social anxiety, specific phobias and separation anxiety. Anxiety is associated with greater care costs. The National Institute of Health reports that pain, depression and anxiety are the most common causes of years lived with disability in America. 

Anxiety comes in reaction to situations we perceive as hazardous. Scanning for patterns, the brain activates our fight or flight system when it notices a potential danger. With anxiety, the nervous system responds as if a threat like a lion is in the room, though the trigger may be something else, such as a difficult client calling in. Our risk-o-meter is working on overdrive. Unending worry is one of the cardinal features of anxiety; those living with it generally notice their worries are excessive but find it tough to shift focus elsewhere. The effects can include restlessness or unease, a sense of impending doom, obsessive thoughts, second guessing, feeling inadequate, mind going blank, irritability, sleep disturbances, fatigue, muscle tension and somatic symptoms. 

Relentlessly anticipating every possible problem can make it hard to focus on conversations and relish joy in ordinary moments. Fears something will go wrong regardless of what you decide can complicate decision making. Perfectionism and pessimism, prevalent traits in attorneys, may increase vulnerability. Trained to search for what could go wrong, attorneys tend to perceive higher stakes. 

Individual therapy and medication are the most effective treatments for anxiety. Cognitive behavioral therapy and exposure therapy are particularly helpful. Results hold up well long term, teaching skills that endure. Counseling can allow lawyers time to process anxious thoughts. Medications for anxiety are widely available and prescribed by a physician or psychiatrist. Half of those who use medications for anxiety report symptom reduction. 

Supplemental approaches to alleviate anxiety include mindfulness, exercise, social support and rest. Consider making exercise part of your routine. Even a short daily walk can help maintain mood and energy. Reach out. Those with more social connections report lower anxiety, greater well-being and more self-esteem. Tiredness can raise vulnerability. Beneficial for those with stressful careers, mindfulness is gaining momentum in the legal profession. It focuses on breathing and savoring each moment. Courses are now available at some law schools; Yale, UC Berkeley and University of San Francisco were some of the first to offer them. Continuously exercising the skill of searching for potential problems, some attorneys find it becomes a challenge to turn this off at will. Mindfulness can improve this.

Jeena Cho, author of The Anxious Lawyer, offers practical suggestions for attorneys dealing with anxiety, such as:

• Sit at your desk, close your eyes and breathe slowly.
• Inhale and exhale slowly before opening your e-mail inbox.
• Stop, take a breath, observe, then proceed mindfully.
• In “3 Tools for Rewiring the Anxious Lawyer Brain,” she recommends:
  • Recognize and name the anxiety.
  • Notice thoughts triggering it.
  • Sweat it out.

Here are a few more simple strategies to decompress. Some can be done anywhere, even in court.

• Count down from 100 with your eyes closed or gaze toward the floor.
• Breathe in slowly for three counts, hold for four counts and breathe out for three counts.
• When you notice panic starting to creep in, breathe deeply, then focus on five objects you see, four things you can feel, three sounds you hear, two scents you smell and one thing you taste.
• When talking about worries doesn't offer relief, try distracting by engaging in an activity.

If you recognize anxiety is taking a toll, contact the Missouri Lawyers’ Assistance Program at 1-800-688-7859 for additional support and resources.

Bibliography

Buchanan, Bree, JD and Coyle, James, Esq. “Moving Forward: Recommendations from the National Well Being Task Force.” Presentation at National Conference for Lawyer Assistance Program, October 18, 2017.

Buchanan, Bree; Coyle, James; Brafford, Anne; Campbell, Donald; Camson, Josh; Gruber, Charles; Harrell, Terry; Jaffe, David; Kepler, Tracy; Krill,

Patrick; Lemons, Donald; Myers, Sarah; Newbold, Chris; Reardon, Jayne; Shaheed, Hon. David; Shely, Lynda; Slease, William and White, Jonathan. The Path to Lawyer Well-Being: Practical Recommendations for Positive Change. Report of the National Task Force on Lawyer Well-Being. https://www.americanbar.org/content/dam/aba/images/abanews/ThePathToLawyerWellBeingReportRevFINAL.pdf, August 14, 2017.

Bandelow, B., & Michaelis, S. “Epidemiology of anxiety disorders in the 21st century.” Dialogues in Clinical Neuroscience, 2015: 17(3), 327–335.

Cho, Jeena. “3 Tools for Rewiring the Anxious Lawyer Brain,” https://abovethelaw.com/2017/08/3-tools-for-rewiring-the-anxious-lawyer-brain/, 11/2/17.Gordon, Leslie A. "How lawyers can avoid burn out and debilitating anxiety," ABA Journal, http://www.abajournal.com/magazine/article/how_lawyers_can_avoid_burnout_and_debilitating_anxiety, July 2015.

Krill, Patrick R. JC, LLM; Johnson, Ryan, MA and Albert, Linda, MSSW. “The Prevalence of Substance Use and Other Mental Health Concerns among American Attorneys,” Journal of Addiction Medicine, http://journals.lww.com/journaladdictionmedicine/pages/currenttoc.aspx, Vol.10 (1), Jan/Feb 2016, pp. 46-52.

Organ, Jerome M; Jaffe, David B. Jaffe and Bender, Katherine M., PhD. “Suffering in Silence: The Survey of Law Student Well-Being and the Reluctance of Law Students to Seek Help for Substance Use and Mental Health Concerns, Journal of Legal Education, 2016(16), 116–56.