What is Anxiety?
Anxiety, a natural emotional response characterized by feelings of worry, nervousness, or unease, typically arises in reaction to stress or perceived threats. While it plays a crucial role in the human “fight or flight” response and can enhance performance in moderate amounts, excessive or persistent anxiety can hinder daily functioning and may indicate an anxiety disorder. Understanding and managing anxiety is essential in both clinical and everyday settings, as it is among the most common mental health conditions. Effective treatment often involves a combination of psychotherapy, particularly cognitive-behavioral therapy, medications, lifestyle changes, and coping strategies, helping individuals to manage their symptoms and improve their overall well-being.
Quick Facts about Anxiety
According to the Anxiety and Depression Association of America:
- Anxiety disorders are the most common mental illness in the United States, affecting an estimated 40 million adults over the age of 18 every year.
- Anxiety disorders are highly treatable, yet only about one-third of those suffering from anxiety seek attention.
People with anxiety are 3-5 times more likely to go to the doctor and 6 times more likely to be hospitalized with psychiatric disorders than those who do not. - Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality and life events.
More than half of those diagnosed with anxiety are also diagnosed with depression. - The term “anxiety” covers a wide gamut of potential symptoms and disorders, such as Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Obsessive Compulsive Disorder, anxiety tied to physical illness, anxiety related to post-traumatic stress, a variety of phobias, and anxiety co-existing with major forms of depression.
- Because there are many forms of anxiety, we will focus here on the two most common forms: Generalized Anxiety Disorder and Panic Disorder. Much of the information below has been excerpted from the National Institute of Mental Health website.
Do you suffer from anxiety? You are not alone . . .
Famous people who have spoken about their anxiety: Oprah Winfrey, Kourtney and Kim Kardashian, Kristen Stewart, Adele, Miley Cyrus, Stephen Colbert, Sarah Silverman, Demi Lovato. Oscar-winning actress Emma Stone has suffered from anxiety since she was a child, as chronicled in her 2018 book I am Bigger than My Anxiety. She told Rolling Stone in an interview: “When I was about seven, I was convinced the house was burning down. I could sense it. Just a tightening in my chest. A feeling that I could not breathe, like the world was going to end. There were some flare-ups like that [as a child], but my anxiety was constant.”
Generalized Anxiety Disorder
People with generalized anxiety disorder (GAD) display excessive anxiety or worry, most days for at least six months, about a number of things such as personal health, work, social interactions, and everyday routine life circumstances. The fear and anxiety can cause significant problems in areas of their life, such as social interactions, school, and work. Generalized anxiety disorder symptoms include:
- Feeling restless, wound-up, or on-edge
- Being easily fatigued
- Having difficulty concentrating; mind going blank
- Being irritable
- Having muscle tension
- Difficulty controlling feelings of worry
- Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep
Panic Attacks and Panic Disorder
Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation. During a panic attack, people may experience:
- Heart palpitations, a pounding heartbeat, or an accelerated heartrate
- Sweating
- Trembling or shaking
- Sensations of shortness of breath, smothering, or choking
- Feelings of impending doom
- Feelings of being out of control
Many people suffer from occasional panic attacks. It is considered a Panic Disorder when someone worries excessively that he or she might experience another panic attack. This can lead to attempting to prevent future attacks by avoiding places, situations or behaviors that they associate with panic attacks. Worry about panic attacks, and the effort spent trying to avoid attacks, can cause significant problems in various areas of the person’s life, including the development of agoraphobia (fear of leaving home).
Treating Anxiety with Psychotherapy
Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety and people should work with their doctor to choose the treatment that is best for them.
Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.
Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
CBT can be conducted individually or with a group of people who have similar difficulties. Often “homework” is assigned for participants to complete between sessions.
Treating Anxiety with Medication
Medication does not cure anxiety disorders but can help relieve symptoms. Medication for anxiety is prescribed by Psychiatric Mental Health Nurse Practitioners, psychiatrists or primary care physicians. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.
Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.
Some benefits of benzodiazepines are that they are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long period of time and they may need higher and higher doses to get the same effect. Some people may even become dependent on them.
To avoid these problems, doctors usually prescribe benzodiazepines for short periods of time, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily.
If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose.
For long-term use, benzodiazepines are often considered a second-line treatment for anxiety (with antidepressants being considered a first-line treatment) as well as an “as-needed” treatment for any distressing flare-ups of symptoms.
A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for the treatment of chronic anxiety, although it does not help everyone.
Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants can take time to work, so it is important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressant medications, especially in the first few weeks after starting or when the dose is changed. Because of this, patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.
Although beta-blockers are most often used to treat high blood pressure, they can also be used to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. These medications, when taken for a short period of time, can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including as a preventive intervention for some predictable forms of performance anxieties.
Choosing the Right Medication
Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with their doctor to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. Patients should talk with their doctor, so they can learn which substances are safe and which to avoid.