Anxiety

Anxiety is one of the most common mental health conditions worldwide, affecting 359 million people in 2021. While everyone experiences anxious feelings from time to time, anxiety disorders involve excessive fear and worry that can interfere with daily life—but effective treatments are available.

Table of contents

• What is Anxiety?
• Types of Anxiety Disorders
• Signs and Symptoms
• What Causes Anxiety?
• How Anxiety is Diagnosed
• Treatment Options
• Managing Anxiety

What is Anxiety?

Anxiety is a feeling of fear, dread, and uneasiness that everyone experiences from time to time^[1]. It is the body’s natural response to stress and can actually be helpful in certain situations. For example, you might feel anxious when faced with a difficult problem at work, before taking a test, or before making an important decision^[2]. This type of anxiety can give you a boost of energy or help you focus and notice dangerous situations to keep you safe^[4].

However, anxiety disorders are different from normal anxious feelings. These are mental health conditions where anxiety does not go away and can get worse over time^[2]. In people with anxiety disorders, fear and worry are both intense and excessive, often accompanied by physical tension and other behavioral and cognitive symptoms^[6]. These feelings are difficult to control, cause significant distress, and can last a long time if untreated^[6].

An anxiety disorder happens when the anxiety interferes with your ability to function, your reactions are often out of proportion to situations, and you cannot control your responses to situations^[4]. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships^[2].

Anxiety disorders are the world’s most common mental disorders. Approximately 4.4% of the global population currently experiences an anxiety disorder, making it more prevalent than any other mental health condition^[6]. In the United States, about 19% of adults struggle with anxiety every day, and nearly one-third of people will experience an anxiety disorder in their lifetime^[5]. Women are about twice as likely as men to develop an anxiety disorder^[4].

Types of Anxiety Disorders

There are several types of anxiety disorders, each with different symptoms and characteristics^[2]:

Generalized anxiety disorder (GAD) causes fear, worry, and a constant feeling of being overwhelmed. People with GAD worry about ordinary issues such as health, money, work, and family, but their worries are excessive and occur almost every day for at least six months^[2]. The worry is characterized by excessive, frequent, and unrealistic concerns about everyday things^[4].

Panic disorder involves sudden, repeated periods of intense fear called panic attacks. These attacks occur when there is no actual danger and come on quickly, typically lasting several minutes or more^[2]. A main feature is that the attacks usually happen without warning and are not due to another mental health or physical condition^[4]. Some people with panic disorder also develop agoraphobia^[4].

Phobias involve an intense fear of something that poses little or no actual danger. When something causes fear or anxiety so severe that it consistently and overwhelmingly disrupts your life, it is called a specific phobia^[4]. People’s fears may be about spiders, flying, going to crowded places, or being in social situations^[2].

Social anxiety disorder (formerly known as social phobia) happens when you experience intense and ongoing fear of being judged negatively or watched by others^[4]. This affects men and women equally^[2].

Agoraphobia causes an intense fear of becoming overwhelmed or unable to escape or get help. People with this condition often avoid new places and unfamiliar situations, such as large open areas, enclosed spaces, crowds, and places outside of their homes^[4].

Separation anxiety disorder happens when you feel excessive anxiety when separated from a loved one, like a primary caregiver. While separation anxiety in babies and toddlers is a normal stage of development, separation anxiety disorder can affect children and adults^[4].

Selective mutism is a condition where a person does not talk in certain situations because of fear or anxiety. It usually affects young children but can also affect adolescents and adults^[4].

Signs and Symptoms

Anxiety disorders can have a combination of mental, physical, and behavioral symptoms. The different types of anxiety disorders can have different symptoms, but they all share certain characteristics^[2].

Common mental and emotional symptoms include feeling nervous, restless, or tense; having a sense of impending danger, panic, or doom; having anxious thoughts or beliefs that are hard to control; trouble concentrating or thinking about anything other than the present worry; and feeling irritable^[2][3]. Many people also experience difficulty controlling worry and fear of the worst happening^[3].

Physical symptoms are common with anxiety disorders. These can include having an increased or rapid heartbeat, breathing rapidly (a condition called hyperventilation), sweating, trembling or shaking, feeling weak or tired, and experiencing unexplained aches and pains^[2][3]. Other physical signs include dizziness, shortness of breath, nausea or upset stomach, and having trouble sleeping^[2][3].

Behavioral changes often accompany anxiety disorders. People may avoid everyday activities they used to do, struggle to form or maintain relationships, and have difficulty looking after themselves^[2][7]. They may avoid places or situations to prevent anxious feelings and become worried about trying new things^[2][7].

Some people experience panic attacks, which are sudden, intense episodes of fear that reach a peak within minutes. A panic attack can cause a racing heartbeat, feeling faint or dizzy, feeling that you are losing control, severe sweating and trembling, shortness of breath or very rapid breathing, a tingling sensation in the fingers or lips, and feeling sick^[16]. Panic attacks typically last between 5 to 30 minutes. While they can be frightening, they are not dangerous and should not cause physical harm^[16].

Using caffeine, certain substances, and some medicines can make symptoms worse^[2].

What Causes Anxiety?

The exact cause of anxiety disorders is not fully understood. However, several factors are believed to play a role, including genetics, brain biology and chemistry, stress, and environmental influences^[2].

Research has shown that both genetic and environmental factors can contribute to a higher risk of developing an anxiety disorder^[2]. There is a biological component to anxiety involving neurotransmitters, which are chemicals in the brain that send messages about how we should feel. If these chemicals are not sending the right messages at the right time, people may be more likely to experience anxiety^[5].

General risk factors for anxiety disorders include certain personality traits, such as being shy or withdrawn when in new situations or meeting new people; traumatic events in early childhood or adulthood; family history of anxiety or other mental disorders; and some physical health conditions, such as thyroid problems or arrhythmia^[2]. Unpredictable bouts of shyness in childhood and exposure to stressful events can also increase risk^[5].

Symptoms of anxiety often have their onset during childhood or adolescence, though anxiety disorders can appear at any time^[6][5]. Nearly one-third of people will experience an anxiety disorder in their lifetime, and these disorders are often diagnosed in early adolescent years^[5].

How Anxiety is Diagnosed

To diagnose anxiety disorders, a healthcare provider will ask about your symptoms and medical history^[2]. You may have a physical exam and laboratory tests to make sure that a different health problem is not the cause of your symptoms^[2]. Some physical conditions can create or increase the severity of anxiety symptoms, such as heart arrhythmia, caffeine intake, or medication side effects^[5].

If you do not have another health problem causing your symptoms, you will receive a psychological evaluation. Your primary care provider may conduct this evaluation, or you may be referred to a mental health professional^[2]. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health conditions, while a psychologist and certain other mental health professionals can also diagnose anxiety and provide counseling^[9].

During the evaluation, your mental health provider may discuss your thoughts, feelings, and behaviors when you feel anxious, and ask about other mental health problems such as depression or alcohol or drug misuse, which can happen along with anxiety and make diagnosis more challenging^[9].

Treatment Options

The main treatments for anxiety disorders are psychotherapy (talk therapy), medicines, or a combination of both^[2][9]. Fortunately, there are several effective treatments for anxiety disorders, and most people can benefit from a combination of approaches^[4]. Although only about 1 in 4 people with anxiety disorders receive treatment for their condition, highly effective treatments exist^[6].

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling, involves working with a therapist to reduce anxiety symptoms. It can be an effective treatment for anxiety^[9].

Cognitive behavioral therapy (CBT) is the most effective form of psychotherapy for anxiety disorders. This structured psychological treatment recognizes that the way we think (cognition) and act (behavior) affects the way we feel^[13]. CBT teaches different ways of thinking and behaving and can help you change how you react to things that cause anxiety^[2]. Generally a short-term treatment, CBT focuses on teaching specific skills to improve symptoms and gradually return to activities you have avoided because of anxiety^[9].

A therapist will work with you to identify unhelpful thought and behavior patterns and help you replace them with new ones that reduce anxiety^[13]. For example, CBT can help you recognize the difference between productive and unproductive worries, teach you how to let go of worries and solve problems, and provide relaxation and breathing techniques to control anxiety and physical symptoms of tension^[13].

CBT includes exposure therapy, in which you gradually encounter the object or situation that causes fear or anxiety, helping you face your fears and prove to yourself you can manage the situation^[9][13]. Avoiding situations that make you anxious prevents you from getting a chance to face your fear^[13].

CBT can be delivered one-on-one with a professional, in groups, or online^[13].

Medications

Antidepressant medications are the medicines of choice in treating anxiety disorders, particularly the newer selective serotonin reuptake inhibitors (SSRIs)^[14]. SSRIs have a safer side effect profile, especially in overdose situations, and are more easily adjusted to effective doses without excessive side effects compared to older antidepressants^[14].

Other antidepressants may also be beneficial for anxiety, including serotonin and norepinephrine reuptake inhibitors (SNRIs) and older medications such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)^[14].

Benzodiazepines are medications that can provide emergency relief for significant discomfort from anxiety. However, they are typically used for short-term management because they can be habit-forming^[14].

It may take some trial and error to discover which treatments work best for you^[9]. You may benefit most from a combination of psychotherapy and medication^[9].

Managing Anxiety

In addition to professional treatment, there are many strategies you can use to help manage anxiety symptoms.

Lifestyle Changes

A healthy lifestyle can help reduce anxiety and improve overall wellbeing. Maintaining a healthy diet with regular meals helps keep energy levels stable^[17]. Include protein, complex carbohydrates (such as oatmeal, quinoa, and whole-grain breads), plus fruits and vegetables in your diet. Complex carbohydrates are synthesized by your body into serotonin, which is a calming chemical that helps reduce depression and anxiety^[17].

Regular physical exercise alone can help manage anxiety and depression. Your body may produce more serotonin and endorphins during exercise, which can have a positive effect on your mind and ability to manage stress^[17]. Working out may also help reduce fatigue, decrease tension, and elevate your mood^[17]. Consider scheduling 30 minutes or more of exercise at least three to five days a week^[17].

Sleep is interconnected with mental health. A lack of sleep can worsen mental health issues, and vice versa. Adults should get seven to nine hours of sleep each night, including on weekends^[17]. A sleep routine that involves going to bed at the same time every night, waking up at the same time every morning, and minimizing daytime naps can help ensure consistent sleep^[17].

Avoiding or limiting alcohol is important, as alcohol may worsen anxiety symptoms. Even one drink may disrupt your natural sleep cycle and leave you feeling restless the next day^[17]. Additionally, if you are taking an antidepressant, mixing alcohol may worsen your symptoms and cause unwanted side effects^[17].

Self-Help Strategies

Learning about anxiety is central to recovery. Education about anxiety, including understanding the physiology of the stress response, helps promote control over symptoms^[11].

Mindfulness guides you to bring your attention back to the present moment and unhook from thoughts that may be unhelpful. When feeling anxious, a person can spend significant time caught up in anxiety-provoking thoughts, and mindfulness can help interrupt this pattern^[11].

Practicing relaxation techniques can help release muscle tension. These include progressive muscle relaxation, abdominal breathing, and isometric relaxation exercises^[11]. Slow breathing exercises can be particularly helpful: count to three as you breathe in slowly, then count to three as you breathe out slowly^[18].

Meditation may help bring a sense of relaxation and a more tranquil mind, reducing stress and calming anxiety. Even a few minutes of meditation can help clear your mind from daily stressors^[17]. There are many different kinds of meditation, from breathing techniques to walking meditation^[17].

Challenging your self-talk is another important strategy. What you think affects how you feel, so try to find new, positive ways to look at situations that make you anxious and examine the facts to see if your thoughts are accurate^[18]. Anxiety can make you overestimate danger in a situation and underestimate your ability to handle it^[18].

Small acts of bravery can help you manage anxious feelings. Try doing something that makes you anxious, even in a small way. Success with small acts of bravery can help you manage anxious feelings for bigger challenges^[18]. Avoiding anxiety triggers can make you feel better in the short term but can increase anxiety in the long term^[18].

Talking about your feelings to a friend, family member, health professional, or counselor can be very helpful. Consider peer support, where people use their experiences to help each other^[16]. Try not to tell yourself that you are alone—most people experience anxiety or fear at some point in their life^[16].

Recovery is possible with appropriate treatment. With the right care, people with anxiety can manage their symptoms and lead happy, successful lives^[5][11].