Most people who meet college student Sarah Fortino would describe her as beautiful, smart and articulate.
How would she describe herself? "I am worry. Worry is my life," she said.
Fortino is a constant worrier, and two of her biggest fears are flying and big cities. She confronted both of those fears when she came to New York City, with the help of Dr. Robert Leahy, the author of "The Worry Cure" and the director of the American Institute for Cognitive Therapy.
Leahy agreed to meet her plane at LaGuardia airport, where she was still shaking from a bumpy ride.
"I started to feel nauseous," Fortino said. "For a moment, I [felt] like, this must have been what it felt like to be on the flight that went into the Trade Center. I actually made myself feel like what it would have felt like, and I started to panic a little bit."
In her car ride into Manhattan, Fortino was anxious about encountering the noise, bright lights, and general chaos of the city. "I can start to feel, just thinking about [it] right now, the tightness in my chest," she told Leahy.
To help Fortino overcome her fear, Leahy used a therapy he calls "verbal exposure." Because when Fortino is flying, her biggest fear is crashing, he tells her to repeatedly say, "The plane is going to crash."
After she said the words over and over again, her anxiety level began to fall.
"If you repeat the thought over and over and over -- hundreds and hundreds of times -- you'll find that the thought becomes less frightening," he said. Leahy also asked Fortino to escalate the ugly thoughts and actually say, "I want the plane to crash."
"It is terrifying," said Leahy, but he also said it was effective. In fact, he asks his patients to set aside "worry time" every day, in which they can repeat their worst fear, and to learn to "accept uncertainty" in life.
'Frightened to Death'
It's important for people like Fortino to seek treatment, says expert Dr. Edward Hallowell, author of "Worry: Hope and Help for a Common Condition" and founder of the Hallowell Center in Sudbury, Mass.
Worrying can have physical effects on the body. Hallowell said, "In fact there's evidence that you can be frightened to death. That you, you can be so worried, so scared that you, you die [of] a sudden heart attack."
It's also important to realize that the standard advice given to worriers, such as telling them "don't worry," is often not helpful.
Hallowell said, "That's like telling someone you're depressed and they say, cheer up."
Hallowell points out that not all worry is bad, in fact, "we're very lucky to be able to worry. … It saves us in all kinds of situations." But he says so-called "toxic" worry should be avoided.
"I think that worry is sort of like a car alarm. If it goes off when it needs to, it's an ally. But toxic worry. … It's going off when it doesn't need to," he said. "Toxic worry is worry that paralyzes you, that leads you to freeze up."
'It's a Problem You Manage'
Hallowell has a simple three-step plan that he says will help 95 percent of people overcome their worries.
Step 1: Never worry alone. Talk to somebody about your worries.
Step 2: Get the facts, because usually toxic worry is based on wrong information or lack of information.
Step 3: Make a plan. Take an active, constructive step. For example, Fortino might bring a distracting movie on the plane when she's anxious.
Making a plan will help you feel more in control, Hallowell says, although don't expect to "solve" your worry problem.
"Worry is not a problem you solve, it's a problem you manage. It's like blood pressure. You're bringing it into the normal zone," he said.
Severe anxiety is a problem for children as well.
Ethan, 11, of Providence, R.I., worries more than his parents. His parents say he obsesses about his fears, including fears of terrorism.
His mother, Stacy said, "At the end of the day, after school, he'll, you know, say, 'Are we still on high alert?'"
She is concerned about the impact of his excessive worrying on his body. "I know kids are resilient. … But I wonder what it's doing to his insides. … To just hold all of that in."
Ethan is being treated at the Providence Center, where he recently met with Dr. Alan Jacobson, the director of Child and Family Services.
Jacobson taught Ethan and his parents practical tips to help him with his excessive worrying. He gave Ethan a "worry doll" to tell his worries to before sleep, as well as a "worry box" to fill with comforting items.
Worry can become so toxic that it leads to phobias. In a dramatic treatment called "exposure therapy," patients with phobias are repeatedly exposed to their fears in a controlled setting.
For example, a person with arachnophobia, or fear of spiders, would first just look at a spider, then touch the glass cage, then touch the spider with a brush, and finally actually hold the spider. This treatment can be effective for some people in as a little as a few hours.
The important lesson is that excessive worry can become manageable. Leahy said, "Worries are like background noise. You don't have to obey them."
For Fortino, even spending one day with Leahy has given her hope.
"He actually got it to one point where I completely relaxed in the car," she said. "It was a fleeting moment where I can see maybe someday I can have more of those times."