What is Anxiety?

Anxiety is a natural response to stress, characterized by feelings of fear, worry, and unease. But when anxiety begins to consistently and negatively impact a person’s life, they may have an anxiety disorder that would benefit from treatment. Anxiety disorders are common mental health conditions that affect millions of people worldwide and include physical symptoms like increased heart rate and sweating, as well as emotional signs such as persistent nervousness, worry, and dread.

Imagine Sara, a successful marketing professional who has always excelled in her career. Lately, she finds herself gripped by an overwhelming sense of dread every morning before work. Meetings that once felt routine now trigger panic attacks, making it difficult for her to focus and perform. Sarah’s experience is not unique; it’s a vivid example of how anxiety can intrude on everyday life, even for those who seem to have it all together.

Understanding anxiety disorders is crucial because they significantly impact daily life, influencing everything from personal relationships to professional performance. Anxiety disorders are among the most prevalent mental health issues, with the World Health Organization estimating that 4% of people globally experience anxiety disorders.¹ By understanding the nuances of anxiety, individuals can better recognize its symptoms, seek appropriate treatment, and reduce the stigma associated with mental health conditions.

This article aims to provide a detailed exploration of anxiety, including its types, causes, symptoms, and treatment options. Whether you are experiencing anxiety yourself or supporting someone who is, this guide will offer valuable insights and practical advice to help navigate anxiety.

Symptoms of Anxiety

Anxiety is a normal part of life and can be a helpful emotion when a person is experiencing a threatening situation. When this reaction is repeatedly triggered in situations where the body and mind’s response is not helpful or even causes problems, a person may have an anxiety disorder.

There are a number of different types of anxiety and the way people experience anxiety can be very different. Anxiety causes a whole-person-response, both mentally and physically. Here are some of the most common symptoms of anxiety.

Emotional Symptoms of Anxiety

People living with anxiety often have thoughts that are filled with worry, which can be about their daily stressors like work or about things that are outside of their control. They may have fears about events that are unlikely to occur, or that seem to be disproportionate to the situation at hand. At times, one may have difficulty managing their thoughts, and one unhelpful thought leads to others that are even more distressing.

How does anxiety affect emotions? If you are experiencing anxiety, your emotions might range from mild uneasiness to intense fear.²

• You may feel uneasy
• You may feel worried
• You may feel irritable
• You may feel panicked or terrified

Physical Symptoms of Anxiety

One of the hallmarks of anxiety disorders are physical symptoms, such as chest pain or racing heart, sweaty palms, headaches, and nausea. People can feel generally restless, on edge, and have trouble sleeping, or at other times feel excessively tired. Given all of these symptoms, people often have trouble concentrating and focusing on tasks. What happens in your body when you feel anxiety? The part of your brain that is in charge of alerting you when it thinks you are threatened will trigger adrenaline, and a number of things happen in the body.

• Muscle tension, which may cause trembles, shakiness, weakness, headaches, neck and shoulder pain, and grinding teeth
• Increased heart rate
• Dilated pupils, which may cause sensitivity to light, blurry vision, or tunnel vision
• Nausea, butterflies, and dry throat
• Feeling cold, tingling, numbness, dizzy or lightheaded due to changes in blood flow
• Trouble concentrating

Behavioral Symptoms of Anxiety

Another common reaction to anxiety is avoidance. Avoidance can look like procrastination in an effort to feel better. However, for many people, avoiding responsibilities or the things that cause them to be anxious only provides temporary relief and can cause their anxiety to get worse over time. ²

What is a panic attack?

Some people with anxiety symptoms or anxiety disorders also experience panic attacks. Panic attacks are a group of physical and mental health symptoms that happen suddenly and can be distressing and very frightening. Because of the intense physical sensations and anxiety, people can feel like they are dying or having a heart attack.

Some symptoms of panic attacks are:

• Palpitations, pounding heart, or an accelerated heart rate
• Sweating
• Trembling or shaking
• Shortness of breath
• Feeling of choking
• Chest pain
• Nausea or abdominal distress
• Feeling dizzy or lightheaded
• Numbness or tingling sensation
• Feeling detached from oneself or reality
• Fear of dying
• Fear of losing control
• Chills or heat sensations²

How anxiety works in the body

The body's anxiety reaction is consistent, regardless of whether the person is actually in physical danger or not. Your brain reacts by pumping out adrenaline and preparing your body physically to fight or to run from the threat - also known as fight-or-flight. Emotionally, these triggers can signal your brain to make you feel anything from slightly worried to uneasy to terrified and panicking. Anxiety reactions in the absence of actual threat can be triggered by several factors.

• Chemical triggers - Chemical substances such as alcohol, marijuana, and some medications can cause feelings of anxiety.
• External stressors - People who are more stressed are more likely to have anxiety.
• Self-talk or unrealistic self-demands - The way we talk to ourselves matters. Overly negative and harsh self-talk, unrealistic expectations of perfection, and punishment for mistakes are ways that we can trigger anxiety for ourselves.
• Physical or medical conditions - Arrhythmia, thyroid disorders, and other conditions can contribute to anxiety symptoms
• Excessive thoughts or rumination about previous experiences where you felt anxiety or fear can trigger recreation of that feeling again.³

The way your brain reacts to these triggers is well-intentioned. Unfortunately, sometimes these reactions are misinformed. When these false alarm triggers cause your brain’s fight-or-flight anxiety response, it can create a cycle that feeds anxiety over time.

What Causes Anxiety Disorders

It’s not completely clear what causes anxiety disorders. However, researchers believe that there are a few influencing factors such as genetics, life experiences, and other health conditions.²

Types of Anxiety Disorders

Anxiety disorders are different in that they involve persistent and excessive symptoms that interfere with an individual’s daily activities, even when there are no life-threatening dangers around. According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental illness and affect nearly 40 million adults in the US - which means over 18% of our population will experience some form of an anxiety disorder in their lifetime.⁴

Though there are many different anxiety disorder diagnoses, they all share two common components: exaggerated fear or anxiety and associated behavior patterns.³

There are several types of anxiety and they can affect people in different ways. You might have heard of specific phobias, social phobia, panic disorder, generalized anxiety disorder, or others. Some of these seem like they might be manageable; like a fear of heights. It’s not always convenient to avoid tall buildings, but you could do it. Others, like panic disorder or social phobia, might be harder to manage, because they cause problems at unpredictable times, like when you’re in public. Each anxiety disorder is different, but they all cause excessive worry that affects thoughts, feelings, and physical symptoms, and that causes problems in a person’s life most of the time for at least six months.³ Three common anxiety disorders are Generalized Anxiety Disorder, Social Anxiety Disorder, and Panic Disorder.

Generalized Anxiety Disorder

Generalized Anxiety Disorder involves persistent and excessive anxiety and worry about a variety of things that a person finds difficult to control. Physical symptoms of Generalized Anxiety Disorder can include restlessness; feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; and sleep disturbance; Some individuals may also experience sweating; nausea and/or diarrhea; irritable bowel syndrome; and headaches.²

Social Anxiety Disorder

Social Anxiety Disorder is the pervasive fear of negative scrutiny by others, such as being humiliated, embarrassed, or rejected in a social situation, either virtually or in-person. Everybody experiences social anxiety to some degree, for example, mild anxiety at parties or about speaking in front of people. Social anxiety disorder occurs when an individual experiences repeated, intense distress in social situations, often resulting in disruption to their day-to-day functioning. For some people, social anxiety leads to avoidance, which can be problematic. If a person becomes unable to interact with others or make or maintain friendships, social anxiety can not only be debilitating, but it can also lead to other mental health challenges, such as depressive disorders.²

Panic Disorder

Because panic attacks are so frightening, once people have one they are often afraid it will happen again. As a result, they might change the things they do, the way they interact with others, their activities, and even how much they go to work or school. This collection of recurring symptoms over time is known as panic disorder.³

Anxiety disorders are diagnosed by a doctor or a mental health professional by learning about your symptoms and their impact on your life, and by comparing your experience to the criteria for anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is published by the American Psychiatric Association and is used by healthcare professionals to determine when a person may have a mental health condition. Your healthcare professional may also run tests to rule out other potential causes for anxiety or identify additional factors to consider, such as other physical health issues. Many healthcare providers will also utilize standardized self-report questionnaires, such as the General Anxiety Disorder 7-Item Scale (GAD-7), to better understand your symptoms and experiences of anxiety.

Anxiety in Children

Anxiety disorders can begin in children as early as age four or five, and become more common in older children and adolescents. It’s not uncommon for a child to have symptoms of or live with an anxiety disorder for as long as two to seven years before an adult in their life seeks help. This is because young children may lack the language to express their symptoms or ask for help and because many adults are unaware that anxiety can affect children.

Signs of anxiety in children:

• School avoidance (repeated absences and/ or excessive nervousness about attending school, daycare, or other routine activities)
• Frequent unexplained physical symptoms such as headaches, stomachaches, or other aches and pains
• Significant fear of being away from their parent or primary caregiver
• Constant thoughts and fears about the safety of loved ones
• Extreme fears about a specific situation or thing (dogs, needles, or insects, for example) that disrupt the child's ability to engage in age-appropriate activities/routines (such as attending a doctor's appointment or going to the park)
• Concerns about being embarrassed or making mistakes
• Avoiding or dropping out of activities
• Being overly quiet and not interacting with others

Identifying anxiety issues in children early allows them to learn how to manage these problems and may prevent symptoms from becoming worse over time. The good news is that anxiety in children is treatable, and early intervention can help avoid future challenges, such as trouble maintaining friendships, underachieving socially and academically, and developing low self-esteem.

If a child's anxiety intensifies and begins to interfere with daily activities, such as separating from parents/guardians, attending school, or making friends, adults should seek an evaluation from a qualified mental health professional or a child and adolescent psychiatrist.⁵

How to Cope with Anxiety

Anxiety disorders are treatable and it is possible to control and manage symptoms with the right tools.

Lifestyle

Certain lifestyle changes and self-care techniques are common parts of treatment plans for an anxiety disorder, including:

• Cutting back on the use of stimulants such as caffeine. These stimulants can worsen feelings of anxiousness.
• Exercising regularly. Regular physical movement can help prevent anxiety and can also help calm you in the moment if you are feeling anxious.⁶

Meditation

Relaxation techniques, controlled breathing, and meditation have also been shown to be effective in reducing the physical symptoms of anxiety.^{6, 7}

• Square breathing: Focus on breathing to slow down your body’s anxiety response. Taking slow breaths helps regulate your heartbeat and gets more oxygen into your system, signaling to your brain that it can be calm. Try square breathing: Breathe in slowly for four seconds, hold for four seconds, breathe out slowly for four seconds, and pause for four seconds.⁸
• Meditation exercises can also be effective for coping with anxiety. Here is a 10-minute guided meditation to help calm anxiety.

Treatment for Anxiety

Psychotherapy for Anxiety

Therapy is a good option for treating anxiety and there are several evidence-based treatments that can treat any type of anxiety disorder.

• Cognitive Behavioral Therapy (CBT) is an evidence-based practice that has been shown to successfully treat anxiety. CBT is used by therapists to help individuals understand how thoughts, feelings, and behaviors influence one another. Cognitive-behavioral therapy and medication are both effective treatments for symptoms of anxiety, especially when used at the same time.²
• Acceptance Commitment Therapy (ACT) is an evidence-based approach that teaches people that thoughts and feelings can be upsetting, but are parts of the human experience. ACT includes mindfulness activities such as meditation, breathing exercises, and other techniques to enhance awareness. ²
• Exposure Therapy is an evidence-based approach in which a trained clinician helps a person experience the source of their fear or anxiety in a safe environment over time to reduce their anxiety and avoidance.⁹

Medication

Medication can be an important part of anxiety treatment for some individuals, especially when combined with other strategies such as therapy or lifestyle changes. It’s important to know about the different kinds of medication for anxiety.

• Selective Serotonin Reuptake Inhibitors, or SSRIs, and Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs: The most common and effective medications for both anxiety and depression. SSRIs and SNRIs are taken daily, are effective for long-term treatment, and help reduce symptoms such as irritability, agitation, frequent crying, and excessive worry. SSRIs or SNRIs are not addictive and do not result in Substance Use Disorder.²
• Benzodiazepines, commonly known as Benzos: Fast-acting medications commonly used to treat significant anxiety symptoms and panic attacks. While effective, these medications can be addictive. They should never be taken in combination with alcohol or opioids, and should only be used as directed by a physician. Safe use of Benzodiazepines can be effective for anxiety symptoms, but should only be used in close collaboration with a doctor and as a part of a larger wellness plan.²
• Beta-blockers: A type of medication usually used for high blood pressure or uneven heartbeat. They can also be effective for the short-term reduction of anxiety symptoms related to heart rate, sweating, or shakiness. Some specific prescription antihistamines can also be used in a similar, short-term manner. These medications can be used on an as-needed basis, especially when specific situations, like flying, impact someone’s life.²

Each class of medication for anxiety has different benefits and risks, and each can offer relief for anxiety symptoms that get in the way of day-to-day life. Most primary-care providers are familiar with these medications -- which, in combination with psychotherapy, such as cognitive-behavioral therapy, are effective treatments for anxiety disorders.

Anxiety symptoms can be overwhelming, but with the right treatment, anxiety can be manageable. Symptoms can be reduced and you can learn positive coping strategies for long-term success.

Summary

Anxiety is the body’s natural protective response to triggers of perceived danger or threat and involves both emotional and physical symptoms. Anxiety is a very common reaction to life events; everyone has experienced anxiety at some point in their lives. When symptoms of anxiety persist and are excessive over a period of time and significantly impact daily activities, this is known as an anxiety disorder.

Anxiety and anxiety disorders are manageable with the right coping techniques, lifestyle changes, and treatment. For many people, a combination of evidence-based psychotherapy and medication has proven effective in reducing symptoms of anxiety disorders and panic disorders.